REVIEW
Introdução: a mielomeningocele pode estar associada a deformidades nas curvas da coluna, incluindo a cifose. Essas deformidades podem ser progressivas e prejudicar a qualidade de vida dos pacientes. Muitas vezes, a cirurgia para correção é necessária. No entanto, não há consenso sobre quando o procedimento cirúrgico deve ser realizado. Assim, o objetivo desta análise é comparar a cifectomia em diferentes faixas etárias. Métodos: revisão sistemática da literatura, realizada pelo protocolo PRISMA. Foi utilizada a estratégia PICOT, onde P - pacientes com mielomeningocele associada à cifose, I - para cifectomia neonatal, C - pacientes que não realizaram cifectomia neonatal, mas que a realizaram em outra idade, e T - período de acompanhamento. Resultados: ao todo, 21 artigos relatando 142 pacientes foram analisados. Os pacientes foram subdivididos em três grupos de acordo com a idade da cirurgia de cifose: neonatal, até dez anos e acima de dez anos. O seguimento médio foi de 3,8 anos (2,3-5,9), e o ângulo médio de correção da cifose foi de 84º (DP = 34º). Todas as populações estudadas apresentaram significância estatística na comparação entre os ângulos de cifose pré e pós-operatórios, reforçando a eficácia da terapia cirúrgica para essa deformidade. Em nossos resultados, todos os grupos apresentaram melhora na qualidade de vida (QV), porém os neonatos apresentaram maior índice de QV. Em nossa análise, não houve diferença entre os grupos durante a avaliação de segurança. Nenhuma morte neonatal foi relatada. Em comparação, os grupos de até 10 anos e acima de 10 anos apresentaram taxa de mortalidade de 1,4% e 0,7%, respectivamente. Conclusão: o presente estudo mostra que a cifectomia é o procedimento cirúrgico de escolha para o tratamento da cifose em pacientes com mielomeningocele, sendo seguro e eficaz em todas as faixas etárias. Além disso, o procedimento realizado em recém-nascidos parece melhorar a qualidade de vida e, se necessário, uma segunda cirurgia tardia será mais direta.
Introduction: myelomeningocele can be associated with spine curve deformities, including kyphosis. These deformities can be progressive and impair patients’ quality of life. Surgery for correction is often necessary. However, there is no consensus on when the surgical procedure should be performed. Thus, the objective of this analysis is to compare kyphectomy in different age groups. Methods: systematic review of literature, performed by PRISMA protocol. The PICOT strategy was used, where P - patients with myelomeningocele associated with kyphosis, I - for neonatal kyphectomy, C - patients who did not undergo neonatal kyphectomy but who underwent it at another age, and T- follow-up period. Results: overall, 21 articles reporting 142 patients were analyzed. The patients were subdivided into three groups according to the age of kyphosis surgery: neonatal, up to ten years old, and over to ten years old. The mean follow-up was 3.8 years (2.3-5.9), and the mean kyphosis corrected angle was 84º (SD = 34º). All subjects studied showed statistical significance in the comparison between pre-and-post-operative kyphosis angles, reinforcing the effectiveness of surgical therapy for this deformity. In our results, all groups presented with an improvement in the quality of life (QoL), nevertheless the neonates had a higher rate of QoL. In our analysis, there was no difference between groups during the safety assessment. No neonatal deaths were reported. In comparison, the groups ‘up to 10 years’ and ‘over to 10 years’ had a mortality rate of 1.4% and 0.7%, respectively. Conclusion: the present study shows that kyphectomy is the surgical procedure of choice for treating kyphosis in patients with myelomeningocele and it is safe and effective in all age groups. In addition, the procedure performed on neonates seems to improve the QoL and if necessary, a late second surgery will be more straightforward.
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1Departament of Medicine, Morgana Potrich College, Mineiros, GO, Brazil.
2MD, Department of Neurological Surgery, Children’s Hospital, Goiânia, GO, Brazil.
3MD, MSc, Department of Neurological Surgery, Children’s Hospital, Goiânia, Goiás; Department of Neurological Surgery, Clinics Hospital, School of Medicine, Federal University of Goiás, Goiânia, Goiás, Brazil.
4MD, Department of Neurological Surgery, Children’s Hospital, Goiânia, Goiás; Department of Neurological Surgery, Clinics Hospital, School of Medicine, Federal University of Goiás, Goiânia, Goiás, Brazil.
Received Jan 21, 2023
Accepted Feb 20, 2023