Myelomeningocele at the sacral level. Long-term outcomes in adults

• Published in: Journal of bone and joint surgery. American volume 1994-09, Vol.76 (9), p.1293-1300
• Main Authors: Brinker, M R, Rosenfeld, S R, Feiwell, E, Granger, S P, Mitchell, D C, Rice, J C
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; Female; Follow-Up Studies; Humans; Locomotion; Male; Malformations of the nervous system; Medical sciences; Meningomyelocele - complications; Meningomyelocele - physiopathology; Meningomyelocele - surgery; Middle Aged; Neurology; Sacrococcygeal Region; Treatment Outcome
• ISSN: 0021-9355; 1535-1386
• DOI: 10.2106/00004623-199409000-00003

We reviewed the long-term outcome of thirty-six patients who had a myelomeningocele at the sacral level and whose average age was twenty-nine years (range, nineteen to fifty-one years). The patients were followed at our institution for an average of ten years (range, one to thirty-three years); however, the medical records from birth on were available for all of the patients. Instead of the expected outcome that function had been maintained in this group of patients, we found a decline in the ability to walk of eleven of the thirty-five patients who had been community ambulators initially. At the time of the most recent follow-up examination, five had become household ambulators, two were non-functional ambulators, and four were non-ambulators. The one patient who initially had been a household ambulator was a non-ambulator at the time of the most recent follow-up examination. A decrease in plantar flexion was found in fourteen patients and a decrease in plantar sensation, in fifteen. Breakdown of the skin and soft-tissue infections on the plantar surface of the metatarsal heads and of the heel were seen in twenty-seven and twenty-three patients, respectively, and were related to the absence of plantar sensation. Fifteen patients had osteomyelitis involving the lower extremity. Eleven patients had had a total of fourteen amputationsfive involved one toe or more, four involved one ray or more, two were Syme amputations, and three were below-the-knee amputations. By the most recent follow-up examination, thirty-three patients had had a total of 371 orthopaedic procedures. The procedures included tendinous procedures; osteotomies; soft-tissue releases, transfers, and débridements; amputations; and arthrodeses of the lower extremities or spine.