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Orthopedic issues in myelomeningocele (spina bifida)

Vineeta T Swaroop, MD
Luciano Dias, MD
Section Editors
Marc C Patterson, MD, FRACP
William Phillips, MD
Deputy Editor
Carrie Armsby, MD, MPH


Myelomeningocele, also known as spina bifida, leads to bowel, bladder, motor, and sensory paralysis below the level of the spinal lesion. Patients with myelomeningocele can have other lesions of the spinal cord (eg, diastematomyelia or hydromyelia) or structural abnormalities of the brain (eg, hydrocephalus), which can also compromise neurologic function. (See "Pathophysiology and clinical manifestations of myelomeningocele (spina bifida)".)

Orthopedic abnormalities in patients with myelomeningocele are caused by unbalanced muscle action around joints, paralysis, and decreased sensation in the lower extremities [1]. Some of these problems are chronic or slowly progressive, and others may arise acutely because of progressive neurologic dysfunction, which might be caused by tethered cord or shunt malfunction.

The main goal of orthopedic care of a patient with myelomeningocele is to correct deformities that may interfere with function. For some patients, functional goals may include ambulation using orthoses [2]. In addition, the orthopedic surgeon must monitor spinal balance and deformity. Because acute changes in orthopedic problems can be caused by acute neurologic events, the orthopedic examination also helps to monitor the neurologic status of the patient.

Orthopedic care of the child with myelomeningocele is made challenging by the presence of multiple medical comorbidities that must be taken into account in any treatment plan. These comorbidities include central nervous system involvement (eg, hydrocephalus), spinal cord complications (eg, syringomyelia and tethering), urinary tract complications (eg, bladder incontinence and renal dysfunction), bowel incontinence, insensate skin, and latex allergy [3]. For this reason, whenever possible, orthopedic care should be rendered as part of a multi-disciplinary team, working together with neurosurgery, urology, and physiatry.

The evaluation and treatment of the common orthopedic problems that affect patients with myelomeningocele are discussed here. The management of their neurologic and urinary tract problems is discussed in a separate topic reviews. (See "Overview of the management of myelomeningocele (spina bifida)" and "Urinary tract complications of myelomeningocele (spina bifida)".)

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Literature review current through: Nov 2017. | This topic last updated: Aug 30, 2017.
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