048. Spinal Morbidity Comparison in Fetal vs Post-Natal Repair of Myelomeningocele Patients

Authors: Martin Piazza, MD

Myelomeningocele results in a number of lifelong SPINE specific disabilities that can require operative management including syringomyelia, symptomatic tethered cord, and scoliosis. With the advent of fetal repair (FR), there have been improvements in Chiari II malformations, lower rates of shunted hydrocephalus, and even better functional mobility outcomes compared to postnatally repaired (PNR) patients. Our study seeks to better understand the spinal outcomes in FR vs PNR in myelomeningocele patients.Methods: We performed a retrospective descriptive analysis of myelomeningocele patients from 2011-2020 who had their initial repair at our institution. Patients lost to follow up were excluded. Patient demographics, surgery type, mobility, presence of syrinx, scoliosis, symptomatic tethered cord, and associated treatments were collected.
A total of 81 myelomeningocele patients were treated and received comprehensive care at our institution. 44 (54%) were treated prenatally and 37 (46%) underwent PNR. Of PNRs, 12 (32%) were eligible for FR. 15 (40%) in the PNR group were mobilizing independently compared to 29 (66%) of FR patients with 5 ambulating unassisted. 6 (13%) of FR had symptomatic tethered cord while 2 (5%) were seen in the PNR. Similar rates of syringomyelia (10) were seen in each group. Scoliosis was seen in 2 (5%) of the FR and 7 (19%) of PNR. TLSO was used to treat 3 PNR, all others were managed expectantly.
Reduction in hydrocephalus and Chiari II in FR myelomeningocele patients is well characterized, but the severity and morbidity of the spinal disabilities are not as well understood. While rates of tethering requiring surgical management are higher in our series and is supported in the literature, FR may either mitigate the severity of early onset scoliosis or support a selection bias for less severe malformation. The rates of syrinx were identical, supporting an often clinically insignificant presence of syrinx in this patient population.