Multisegmental Lumbar Corporectomy and Transcorporal Fixation for Correction of Extreme Thoracolumbar Kyphosis in Myelomeningocele with Chronic Decubitus.

We introduce a novel technique for the treatment of severe kyphosis in myelomeningocele. A 5-year-old paraplegic boy with myelomeningocele presented with severe thoracolumbar kyphosis and a chronic ulcus at the site of the gibbus. The myelomeningocele had been treated during his first week of life, and an accompanying Chiari type II malformation had been treated by ventriculoperitoneal shunting. He subsequently developed a rapidly progressive thoracolumbar kyphosis with an angle of 180° between T10 and L5. He also suffered from a chronic superinfected skin ulcus at the site of the gibbus. Since the skin ulcus required plastic surgery reconstruction, we deemed classical posterior fixation after kyphectomy unfeasible. The subsequent operative steps of our novel surgical approach were performed in a single-stage surgery. First, a three-level lumbar corporectomy from L1 to L3 was performed. Subsequently, the body of the removed L2 vertebra was isolated and configured as an autologous graft to bridge the gap between the thoracic and the caudal lumbar spine. The graft was fixed via a transcorporal interbody fusion technique with titanium screws, and chopped autologous bone was added for fusion. The skin was closed using rotation flaps. At the 3-year follow-up, the patient and his family reported marked improvement of quality of life, imaging showed solid fusion and the wound was unremarkable. Our novel technique with transcorporal fixation provides new perspectives in the treatment of severe kyphosis and skin ulceration in myelomeningocele.

When Fat Hits the Brain: Intraventricular and Subarachnoid Fat Migration Secondary to a Complex Sacropelvic Fracture-Diagnosis and Treatment.

Massive migration of fat droplets in the ventricles and the subarachnoid space is a very rare sequel of spinal trauma. Owing to its rarity, knowledge about treatment and outcome remains limited. We report on the uncommon occurrence of massive subarachnoid and intraventricular fat dissemination in a 41-year-old man who suffered a complex sacropelvic fracture with spondylopelvic dissociation but who had no head injury. We show that early placement of an external ventricular drain with prolonged drainage for washout of the fat depots can prevent chronic hydrocephalus and subsequent shunt dependency.