Orthopaedic outcomes of prenatal versus postnatal repair of myelomeningocele

Abstract

Myelomeningocele, characterized by extrusion of the spinal cord through a spinal canal defect, is the most common form of spina bifida, often resulting in lifelong disability and significant orthopaedic issues. A randomized controlled trial (RCT) has shown the efficacy of prenatal repair in decreasing the need for shunting and improving motor outcomes. However, no studies have evaluated the effects of prenatal repair on orthopaedic outcomes. The purpose of this study was to determine the rates of orthopaedic conditions in patients with prenatal and postnatal repair of myelomeningocele and compare the rates of treatment required. This study analyzes the relevant outcomes from a prospective RCT (Management of Myelomeningocele Study). Eligible women were randomized to prenatal or postnatal repair, and patients were evaluated prospectively. Outcomes of interest included rates of scoliosis, kyphosis, hip abnormality, clubfoot, tibial torsion, and leg length discrepancy (LLD) at 12 and 30 months. The need for orthopaedic intervention at the same time points was also evaluated. Statistical analyses included descriptive statistics and univariate analyses. Data for the full cohort of 183 patients were analyzed (91 prenatal, 92 postnatal). There were no differences in rates of scoliosis, kyphosis, hip abnormality, clubfoot or tibial torsion between patients treated with prenatal or postnatal repair. The rate of LLD was lower in the prenatal repair group at 12 and 30 months (7 vs. 16% at 30 months, P = 0.047). The rates of patients requiring casting or bracing were significantly lower in patients treated with prenatal repair at 12 and 30 months (78 vs. 90% at 30 months, P = 0.036). Patients treated with prenatal myelomeningocele repair may develop milder forms of orthopaedic conditions and may not require extensive orthopaedic management.

Development of a core outcome set for the orthopaedic management of spinal dysraphism

“…Weakness leads to muscle imbalance with secondary complications, such as scoliosis, hip dislocation, talipes equinovarus, and torsional abnormalities of the growing bones, 4,5 with an associated and potentially severe impairment in terms of walking ability. These children require collaborative multidisciplinary care due to the spectrum of coexisting comorbidities.…”

Association of Location of Cyst with the family history and Mutated Gene among patients of Myelomeningocele

“…Neurologic disability is mostly related to interruption in the growth of neural placode which would lead to sensory and motor deficit in the bladder/ bowel continence and also would result in lower limb paralysis 5 . Secondary neurologic deficit may lead to hydrocephalus 6 , Arnold Chiari malformation 7 and scoliosis 8 . Furthermore, in long term surviving patients, the disability could be aggravated due to orthopedic problems 9 such as dislocated hips, foot or ankle deformities and joint contractures and tightness.…”