Neurological abnormalities, major orthopaedic deformities and ambulation analysis in a myelomeningocele population in Catalonia (Spain)

Abstract

The aim of the study was to analyze the present status of neurologic abnormalities, major orthopaedic deformities and ambulatory status in a large myelomeningocele population. Patients and methods: Cross-sectional study based on the clinical and radiographic records of 322 patients treated and followed-up from 1967 ± 1995. The setting was a multidisciplinary spina bi®da unit within a third-level university hospital, which serves as the referral centre for these patients in Catalonia (Spain). We collected information on diagnosis, central nervous system, musculoskeletal system (spinal and hip deformities) and functional level in each patient. To study relationships among the variables, the Mann-Whitney U and the Chisquared tests were applied. Results were considered to be statistically signi®cant at P levels of 40.05. Results: Mean age was 15.9 years. 78.1% of patients had mid-lumbar, low-lumbar or sacral neurological levels; 97.5% had hydrocephalus and 68.8% were shunted. Prevalence of spine deformities was 45.3%; 38.8% had dislocation of one or both hips. Median age of walking onset was 37.1 months and 74.8% of patients were ambulatory. Median age at which ambulation ceased was 128 months (10 years and 8 months). The bivariate analysis showed statistically signi®cant relationships between neurological level and all the variables studied (P50.001, P50.02) except body mass indexes and intelligence quotient. Conclusions: Neurological level was the main factor that determined neurological abnormalities, major orthopaedic deformities and ambulatory status.

Who needs surgery for pediatric myelomeningocele? A retrospective study and literature review

“…Patients with higher neurological levels more frequently needed shunts, which is a finding already recorded in other studies. 21,26,28,31,36 Our data show that shunt placement in MMC carried a high risk of revision. We confirmed that most shunt revisions occur during the first 6 months to 1 year of life.…”

Muscle Activation Patterns in Infants With Myelomeningocele Stepping on a Treadmill

“…3–5 In children with lesions above the sacral level who learn to walk independently, sensorimotor deficits contribute to delays in walking onset and long-term gait difficulties. 6 For example, the median age of walking onset is 3 years 7 with concomitant impairments that often require the use of assistive devices to support and stabilize movement.…”

Stepping Responses of Infants With Myelomeningocele When Supported on a Motorized Treadmill

“…Current data suggest a 20% chance of walking for those born with lesions at a high lumbar level, 80% for infants with lesions at a low lumbar level, and 90% for infants with lesions at the sacral level. 8,9 Unfortunately, by late childhood to early adolescence, many children with MMC are unable to maintain upright locomotion for community mobility and transition to wheelchair use; this transition introduces or reinforces significant comorbidities, such as scoliosis and obesity. 10,11 The possibilities for nonsurgical early therapeutic interventions that might help infants with MMC acquire stronger and better functional control of their lower limbs have largely been neglected.…”