Functional gait comparison between children with myelomeningocele: shunt versus no shunt

Abstract

The aim of this study was to compare functional gait differences between patients with myelomeningocele (MM) who have a ventriculoperitoneal shunt (VPS) with those who do not. Our analyses were adjusted for confounding by age, lesion level, orthotic use, and assistive device use. The Functional Mobility Scale (FMS) was used to compare the shunted group (n=98; 60 males, 38 females; mean age 10y 2mo [SD 3y 11mo]; 73 sacral/19 low lumber/six high lumbar lesion level) with the non-shunted group (n=63; 32 males, 31 females; mean age 9y 11mo [SD 3y 11mo]; 45 sacral/12 low lumber/six high lumbar lesion level). Participants with a shunt had lower FMS 500 and FMS 50 scores compared with participants without a shunt; hence the participants without a shunt were more independent in their ambulation at medium and longer distances. For a subset of participants who underwent a three-dimensional gait analysis, we also collected temporal-spatial gait parameters (velocity, cadence, and stride length). Our results show that participants with MM and no shunt who underwent gait analysis(11 males, 10 females; mean age 9y 6mo [SD 4y]; 15 sacral/6 low lumber/0 high lumbar lesion level) tend to walk at a significantly greater velocity and stride length as compared with those with a shunt (33 males, 18 females; mean age 10y [SD 4y]; 38 sacral/13 low lumber/zero high lumbar lesion level). These data allow the treatment team to present more specific information regarding functional ambulatory expectations to patients with MM and their families.Hydrocephalus is an abnormal accumulation of cerebrospinal fluid in the ventricular system as a result of an obstruction and occurs in approximately 85 to 90% of patients with myelomeningocele (MM). 1-3 Several pathophysiological mechanisms may cause hydrocephalus in patients with MM. All have potentially a common origin in the Chiari II caudal hindbrain anomaly that is present in virtually all patients with MM. [1][2][3] Hydrocephalus is often treated with a ventriculoperitoneal shunt (VPS). Two possible strategies towards the timing of VPS placement include immediate VPS placement and delayed VPS placement. In the first strategy, if observable hydrocephalus is present, the neurosurgeon recommends repairing the MM and placing the VPS during the initial newborn admission. [3][4][5][6] A second strategy is for the VPS placement to be performed post-MM repair if the clinical signs and symptoms of hydrocephalus are found to be progressive. 1,7 Up to 50% of all shunted children with MM will require multiple shunt revisions 8 and shunt malfunction and complications remain an important cause of morbidity and mortality in patients with MM. 5,[9][10][11][12][13] Studies have related significant factors for successful functional outcomes in patients with MM, such as cognitive status, muscle strength, and lesion level; 14-17 however, the effect of shunting on mobility has not been determined. The purpose of conducting this study is to provide families and members of the spina bifida treatment team with more de...

Activity Level, Functional Health, and Quality of Life of Children with Myelomeningocele as Perceived by Parents

“…Many other studies reported a similar association [2,3,11,12,16,28]. Davis et al [9] looked at 158 adolescents and reported 84% of the individuals were shunted.…”

“…Children with more than four shunt revisions also have a lower functional level [2,11,12,28]. Transition from childhood to young adulthood can be an especially difficult developmental period for those with MM [14].…”

Orthopedic management of spina bifida. Part I: Hip, knee, and rotational deformities

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“…The recurrence of NTDs is greater than 5% for a women having more than one child affected by NTDs. 19,20 Following factors contribute in the epidemiology of NTDs:…”