Novel Reconstruction Plate Augmentation Technique for Treatment of Myelomeningocele-Associated Severe Kyphotic Deformity: A Case Series of Three Patients

Study Design: Case series. Objective: This case series presents a novel technique using DCP AO reconstruction plates to augment posterior spinal constructs in patients with MMC-associated kyphotic deformities. Summary of Background Data: Patients with myelomeningocele (MMC) and severe kyphotic gibbus deformities experience difficulties with sitting and lying flat, leading to increased skin breakdown and risk of infection. Many patients undergo kyphectomy, cordotomy, and long-segment posterior spinal instrumentation using well-established techniques to correct sagittal alignment. However, these treatments still face very high rates of instrumentation failure and wound issues. Dynamic compression (DCP) AO reconstruction plates have been successfully used in other areas of orthopedics to provide additional stability, fracture reduction, and promote bony healing. Materials and Methods: Three patients were treated with kyphectomy, cordotomy, posterior fusion, and augmentation using contoured DCP AO plates. Two patients underwent the Fackler technique, which involved placing titanium rods into the S1 foramen with cantilever bending to correct the kyphotic deformity. Results: All patients demonstrated successful outcomes. The first patient, with a 31° kyphotic deformity and T12–L1 nonunion, underwent T4-pelvis fusion and achieved stable correction at two-year follow-up without instrumentation failure or wound complications. The second patient, with a 160° midthoracic gibbus deformity, underwent L1–4 kyphectomy and T10-pelvis fusion using the Fackler technique and a DCP AO reconstruction plate. Postoperative results showed stable deformity correction and no complications at beyond one-year follow-up. The third patient, with a 170° thoracolumbar gibbus deformity, underwent L2–L5 kyphectomy and T9-sacrum fusion with the Fackler technique and augmentation using a DCP AO reconstruction plate. At both one-year, two-year, and three-year follow-ups, the patient had no wound breakdown, instrumentation failure, or need for revision surgery. Conclusion: The use of a DCP AO reconstruction plate offers a promising augmentation strategy for managing severe kyphotic deformities in MMC patients. Further studies are needed to assess long-term outcomes and the broader applicability of this approach.