Published: May 13, 2026
A neonate was born with a prenatally diagnosed myelomeningocele, the most severe type of spina bifida, and severe associated myelokyphosis. Due to the extent of the bony deformity, prenatal surgery was deemed too high risk. At birth, the patient presented with a large open neural tube defect with exposed spinal cord and abnormal spinal alignment. Pediatric orthopedic spine surgery was consulted on day 1 of life to assist with deformity correction prior to definitive neurosurgical and plastic surgical closure.
Standard postnatal management of myelomeningocele typically involves early closure of the defect by fetal surgery and post-birth plastic surgery. In this case, the severity of the kyphotic deformity prevented safe closure due to inadequate alignment and soft tissue coverage.
Additionally, there is limited published case report guidance on operative management of neonatal myelokyphosis of this complexity. The surgical challenge was to achieve sufficient spinal realignment to allow closure of the defect while minimizing bone resection and avoiding premature spinal fusion that could compromise future growth and function.
A multidisciplinary surgical plan was developed involving pediatric orthopedic spine surgery, pediatric neurosurgery and pediatric plastic surgery. On day 2 of life, the orthopedic team performed kyphosis reduction to improve spinal alignment and create a stable platform for defect closure.
A novel technique was employed using a spinal implant typically utilized in pediatric scoliosis surgery. The implant was selected to provide adequate strength for deformity correction while limiting bone removal and preserving growth potential. Following successful realignment, neurosurgery and plastic surgery proceeded with closure of the myelomeningocele defect and soft tissue coverage during the same operative course.
Postoperatively, the patient recovered without major complications and continues to be followed through a multidisciplinary team at Norton Children’s Spina Bifida Clinic. The surgical incision demonstrated satisfactory healing with intact soft-tissue coverage and no wound-related complications.
At nearly 1 year of age, the patient has demonstrated meaningful neuromuscular and developmental progress, including independent sitting and initiation of crawling. Early spinal realignment and defect closure appear to have contributed to improved postural stability and preservation of lower extremity function compared with expected outcomes in similarly severe presentations. Ongoing follow-up will continue to assess neurological function, spinal growth and urological outcomes.
Kent L. Walker, D.O.
Pediatric Orthopedic Spine Surgery
Joshua W. Meier, M.D.
Thomas M. Moriarty, M.D.
Pediatric Neurosurgery
Mark E. Chariker, M.D.
Pediatric Plastic Surgery
Reviewed by Kent L. Walker, D.O., and Joshua W. Meier, M.D.