Evidence map›Paper›PMID 41934572›Full record

ArticleSpine deformity2026

Evolving surgical strategies in myelomeningocele (MMC): shift toward index fusion with stable complication rates.

Edwin S Kulubya, Matthew J Weintraub, Omar Taha, Mehdi M Elfilali, Chidebelum O Nnake, Alexander M Park, Michael W Brown, Taemin Oh, John T Smith, Paul D Sponseller and 4 more

Abstract readMulticenter Study
PubMed Publisher
In one paragraph

Article in Spine deformity, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

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0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

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PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors.

Edwin S KulubyaBoston Children's Hospital, Boston, MA, USA.
Matthew J WeintraubRutgers Health New Jersey Medical School, Newark, NJ, USA.
Omar TahaEastern Carolina University Brody School of Medicine, Greenville, NC, USA.
Mehdi M ElfilaliColumbia University Irving Medical Center, New York, NY, USA. mme2145@cumc.columbia.edu.ORCID http://orcid.org/0009-0007-1347-022X
Chidebelum O NnakeColumbia University Irving Medical Center, New York, NY, USA.
Alexander M ParkColumbia University Irving Medical Center, New York, NY, USA.
Michael W BrownColumbia University Irving Medical Center, New York, NY, USA.
Taemin OhColumbia University Irving Medical Center, New York, NY, USA.
John T SmithDepartment of Orthopaedic Surgery, The Orthopaedic Partners, Park City, UT, USA.
Paul D SponsellerDepartment of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA.
Purnendu GuptaDepartment of Orthopaedic Surgery, Shriners Children's Chicago, Chicago, IL, USA.
Lawrence I KarlinBoston Children's Hospital, Boston, MA, USA.
Michael G VitaleColumbia University Irving Medical Center, New York, NY, USA.
Pediatric Spine Study Group (PSSG)

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeThis study examines trends in surgical management and outcomes in patients with myelomeningocele (MMC) undergoing spine surgery, focusing on complications and radiographic outcomes.

methodsA retrospective review of a multicenter registry was conducted. Demographics, surgery type, ambulatory status, and radiographic parameters were collected. Complications occurring within five years post-index surgery were recorded and classified by the Modified Clavien-Dindo-Sink (MCDS) scale. Patients were divided into "early vs. late" groups based on the median time point, and by ambulatory status. Complication rates were evaluated over five-year intervals. Statistical analyses included t-tests, Mann-Whitney U, chi-square, and Cochran-Armitage trend tests.

resultsThe cohort included 187 MMC patients, with 161 undergoing growth-friendly (GF) procedures and 26 index fusions. 119 patients (63%) experienced major complications (MCDS ≥ III), predominantly wound-related (79). The late group was older at index surgery (6.7 vs. 7.7 years, p = 0.031) and had a higher rate of index fusion (7.5% vs. 20.2%, p = 0.022). Preoperative and postoperative radiographic parameters were similar. Among GF patients, 71 underwent definitive spinal fusion. On average, patients treated with VEPTR/TGR underwent 5 lengthening procedures, while those treated with MCGR underwent 8. Across all GF patients, the average number of unexpected reoperations was 1.6. Overall five-year complication rates did not differ significantly between early and late cohorts (66.7% vs. 60.6%; p > 0.05). A declining trend in complication rates over time was observed (p = 0.082).

conclusionsFrom 2002-2019, surgical management of MMC evolved toward increased index fusion and older age at index, possibly to reduce repeat surgery risks. Despite this, radiographic outcomes and overall complication rates were similar between early- and late-era cohorts, and a downward trend in complications that approached statistical significance was observed over time. LEVEL OF EVIDENCE: IV.

Indexed as

MeningomyelocelePostoperative ComplicationsSpinal FusionAdolescentChildChild, PreschoolFemaleHumansMaleRadiographyRegistriesRetrospective StudiesTreatment OutcomeComplicationsGrowth-friendly instrumentationMyelomeningoceleSpinal fusionSurgical trends

Identifiers

PMID41934572

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