Abstract
<jats:p>Myelomeningocele (MMC), the open form of spina bifida, remains a global condition despite preventive folate strategies, and long-term survival into adulthood is now expected. As longevity has improved, spinal and pelvic deformities – particularly congenital lumbar kyphosis – have become major drivers of sitting tolerance, skin integrity, independence, and caregiver workload. In MMC, deformity is rarely a purely radiographic problem: Altered alignment changes pressure distribution in insensate tissues, amplifies ulcer risk over the apex and sacropelvis, and can undermine transfers, hygiene, and ambulatory function. This chapter provides a practical, goal-directed framework for evaluation and treatment of MMC-related lumbar kyphosis, emphasizing patient-centered outcomes and complication prevention. We summarize the phenotype and natural history of rigid lumbar gibbus, outline a structured clinical and imaging work-up that reflects functional loading and define surgical indications in terms of function and skin risk rather than angles alone. Operative options are reviewed from kyphectomy-based reconstructions (short- vs. long-segment stabilization, sacropelvic fixation) to growth-friendly strategies for children with meaningful growth remaining. Because published series consistently report high complication rates – dominated by wound breakdown, infection, implant prominence, and mechanical failure – we synthesize mitigation strategies as a multidisciplinary perioperative pathway: preoperative optimization, proactive soft-tissue planning, standardized intraoperative blood and closure strategies, and structured postoperative pressure management, seating, surveillance, and rehabilitation. Across techniques, success is defined by a durable, pressure-safe sitting profile, ulcer control, reduced caregiver burden, and minimized unplanned reoperations.</jats:p>