The Journal of Bone and Joint Surgery, Vol 76, Issue 9 1293-1300, Copyright © 1994 by Journal of Bone and Joint Surgery, Inc
Myelomeningocele at the sacral level. Long-term outcomes in adults
MR Brinker, SR Rosenfeld, E Feiwell, SP Granger, DC Mitchell and JC Rice
Spina Bifida Clinic, Rancho Los Amigos Medical Center, Downey, California 90242.
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 amputations: five 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 debridements; amputations; and arthrodeses of the
lower extremities or spine.
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