A rare case of anterior thoracic myelomeningocele with scoliosis-case report and review of the literature

BACKGROUND CONTEXT: Spinal deformities associated with spinal dysraphism are a challenging problem. Myelomeningocele has been reported in the lumbar spine. However, it is rare in the thoracic spine. PURPOSE: The purpose of the report was to heighten the awareness of the rare presentation of the myelomeningocele in the thoracic spine and the ability to correct the scoliosis without debulking the lesion. STUDY DESIGN: This is a clinical case report and literature review. METHODS: We report a 13-year-old girl presented with complaints of back pain, difficulty in breathing, and easy fatigability. On examination, she had a thoracolumbar scoliosis, weakness of the right ankle dorsiflexors, and impaired sensation over the L5 dermatome of the right lower limb. Radiographic examination revealed a 128 degrees thoracolumbar scoliosis with congenital hemivertebra at T6-T9, block vertebrae of T4 and T5, and intrathoracic myelomeningocele. She underwent an anterior closing wedge osteotomy and posterior correction of scoliosis without removal of the sac. RESULTS: Four-year postoperative follow-up is uneventful. To date, our patient is the first patient who had scoliosis correction surgery for the rare presentation of a myelomeningocele in the thoracic spine without removal of the sac. CONCLUSIONS: To the best of our knowledge, this is the only case of anterior thoracic myelomeningocele with scoliosis in the literature who had undergone a surgical correction of the scoliosis with osteotomy without removal of the sac. Although rare, these curves are well amenable to surgical correction of scoliosis, thereby improving endurance and functional lung capacity. (C) 2011 Elsevier Inc. All rights reserved.