Predictive Factors in Open Myelomeningocele with Special Reference to Sensory Level

British medical journal 11/1973; 4(5886):197-201. DOI: 10.1136/bmj.4.5886.197
Source: PubMed


A total of 113 cases of open myelomeningocele operated on shortly after birth were followed up and the 80 survivors (71%) were assessed one and a quarter to seven and a half years later. Their disability was classified in terms of mobility, intelligence, continence, and major complications; these when combined provided an assessment of overall disability. The overall disability of the survivors was minimal in 6%, moderate in 40%, severe in 39%, and very severe in 15%.A number of clinical features present at birth were analysed for their predictive value. Of these the sensory level, which frequently differed from both external and radiological levels of the lesion, correlated with the outcome in terms of mobility, intelligence, continence, major complications, and overall disability; and also with deaths caused by renal failure.A policy of confining operation to those patients with a reasonable chance of achieving independence would involve selecting for treatment a minority of all infants born with open myelomeningocele.

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    • "In children, the risk of renal failure is strongly related to the sensory level (which may not be the same as the anatomic level in the spine or the level suggested by X-ray). Renal failure is rare with sensory levels at or below L4 and common at or above T10 [4]. However, renal failure can occur even with apparently minor neural tube defects such as occult spinal dysraphism. "

    Full-text · Article · Jun 2006 · European Urology
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    • "When first surveyed at the mean age 4 years, the cohort had been classified into four groups according to sensory level to pin prick recorded in infancy [4]. Those with intact sensation right down to the knee (sensory level below L3) had a better short-term outcome than those with no sensation below the umbilicus (sensory level above T11). "
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    ABSTRACT: Background and Methods From 1963 to 1971, 117 babies with open spina bifida were treated non-selectively from birth. In 2002 we reviewed all the survivors by postal questionnaire and telephone call. The aims were to find out how many were living independently in the community or were in open employment or drove a car. In addition to these achievements we recorded health, medication and admissions to hospital and asked how much daily help they needed. Results Ascertainment was 100%. There had been 63 deaths, mainly of the most severely affected. The mean age of the 54 survivors was 35 years. The outcome in terms of disability ranged from apparent normality to total dependency. It reflected both the neurological deficit, which had been recorded in infancy in terms of sensory level, and events in the CSF shunt history. Overall about 2 in 5 of the survivors lived independently in the community, 2 in 5 drove a car, 1 in 5 was in competitive employment and 1 in 5 could walk 50 metres. Conclusion Although those who survived to age 35 years tended to be less disabled, 2 in 5 continued to need daily care.
    Full-text · Article · Jan 2005 · Cerebrospinal Fluid Research
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    ABSTRACT: Patients with myelomeningocele who would formerly have died are now surviving as a result of treatment. 77 treated survivors were visited at home to discover the implications for the child and the family. Most families made great effort and sacrifice for their child, but the results achieved were often disappointing. For some children the combination and severity of their handicaps will result in lifelong dependence. Since the degree of disability can be predicted at birth, careful selection for operation would be humane policy.
    No preview · Article · Jan 1974 · The Lancet
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