PMC7704212_01
(a, b) Arachnodactyly and contractures of the proximal interphalangeal joints, (c) dental malpositioning, and (d) emaciation and minimal subcutaneous tissues.
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fig1
Delayed mental development, ligamentous laxity, emaciation, arachnodactyly, and dental malpositioning were confirmed (Figure 1).
(a) Preoperative X-ray:anterior-posterior (AP) view of levoscoliosis (T10-L5: 80 ) and (b) preoperative X-ray:lateral view.
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Preoperative axial CT. Dural ectasia and massive intraperitoneal myelomeningocele.
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fig3
Intraoperative photo; myelomeningocele was confirmed at the posterior left side L5 level.
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MEP and SEP monitoring. Myelomeningocele was confirmed during the surgery (Figure 4).
(a) Postoperative X-ray:AP view, levoscoliosis (T10-L5: 43 ); (b) postoperative X-ray:lateral view; (c) rod breakage X-ray:AP view; (d) rod breakage X-ray:lateral view; (e) last follow-up X-ray:AP view; (f) last follow-up X-ray:lateral view.
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fig5
Postoperative correction was performed at T10-L5: 43  (Figures 5(a) and 5(b)). A break in a rod was confirmed one year and three months postoperatively (Figures 5(c) and 5(d)); and thus, the rod was replaced and fused again. The vertebra has autofused, and follow-up results are favorable (Figures 5(e) and 5(f)).
Postoperative axial CT: (a) T9, (b) T10, (c) L1, (d) L2, (e) L3, (f) L4, and (g) S1.
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fig6
Therefore, accurate insertion of pedicle screws by using a navigation system was considered essential in obtaining sufficient correction and fusion (Figure 6).