Congenital kyphotic spinal deformities in children with myelomeningocele are usually progressive and can impair sitting posture. Kyphectomy is classically performed to restore spinal alignment, but the procedure is historically associated with high complication rates. There are several variations of kyphectomy surgery. We favor an all‐posterior, modified Warner and Fackler procedure with plate fixation. A 5‐year‐old, nonambulatory female with a history of myelomeningocele repaired at birth presented with a progressive, semirigid 132° lumbar kyphosis to clinic during a surgical mission trip to Colombia. The lumbar kyphosis was increasingly impairing her sitting posture and balance. We indicated this patient for kyphectomy surgery involving an all‐posterior, modified Warner and Fackler procedure with long S‐shape rods cantilevered against the anterior sacrum and posterior plate fixation for spinal fusion and deformity correction. A modified Warner and Fackler procedure with long S‐shape rods anchored in the first sacral foramen and cantilevered against the anterior sacrum with posterior plate fixation is our preferred technique for kyphectomy in myelomeningocele patients with lumbar kyphosis to restore spinal alignment and reduce lumbosacral instrumentation prominence.
Sarmiento et al. (Thu,) studied this question.