ArticleChild's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery2025
Prevalence of spinal deformities in myelomeningoceles treated in utero and postnatally, utilizing 3D external orthopedic system (EOS) panoramic radiographic technology.
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Abstract
purposeThis study analyzes the prevalence of spinal deformities in patients who underwent in utero myelomeningocele (MMC) repair compared to those who had postnatal surgery.
methodsPatients treated at Hospital São Paulo and Hospital e Maternidade Santa Joana between 2006 and 2021 were included. Selection was retrospective; external orthopedic system (EOS) imaging was performed prospectively. Only patients under 18 at the time of imaging were analyzed. Data collected included birth metrics, need for ventriculoperitoneal shunt, urinary/fecal incontinence, and postnatal complications. Radiographic analysis assessed scoliosis, pelvic parameters, and sagittal balance. Groups were compared using statistical tests (p < 0.05).
resultsSeventy patients were evaluated: 47 had in utero repair and 23 postnatal. Groups were similar in age (p = 0.089) and gender (p = 0.725), but the in utero group had lower birth weight (p = 0.024) and gestational age (p = 0.004). Ventriculoperitoneal shunt requirement (p = 0.001), scoliosis incidence (p = 0.020), and urinary incontinence (p = 0.009) were significantly lower in the in utero group. Cobb angle did not differ significantly. Most postnatal complications were comparable, except for lower axial pelvic rotation in the in utero group (p = 0.024).
conclusionIn utero MMC repair is associated with reduced rates of acquired scoliosis, need for shunting, and urinary incontinence, indicating a better overall prognosis compared to postnatal surgery.
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