Anterior fusion insufficient for scoliosis in myelomeningocele: 8 children 2–6 years after the Zielke operation

8 children with a mean age of 13 years with paralytic scoliosis due to myelomeningocele (MMC) were operated on according to Zielke with anterior fusion and instrumentation. There were no infections. All fusions healed. The postoperative mean follow-up was 4 years. The average correction of the primary curve was 62 degrees. In 5 cases proximal curve progression required reoperation; posterior fusion with Harrington rods was also done. Our last 2 patients, primarily operated on with both an anterior and posterior fusion, had no postoperative progression. Anterior fusion according to Zielke as the only procedure cannot be recommended in the treatment of severe paralytic scoliosis due to MMC. We advise a combined anterior and posterior approach in these cases.