title: Myelomeningocele at the sacral level. Long-term outcomes in adults.
abstract: 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 débridements; amputations; and arthrodeses of the lower extremities or spine.
authors.affiliation: Spina Bifida Clinic, Rancho Los Amigos Medical Center, Downey, California 90242.
authors.forename: M R
authors.initials: MR
authors.lastname: Brinker
authors.forename: S R
authors.initials: SR
authors.lastname: Rosenfeld
authors.forename: E
authors.initials: E
authors.lastname: Feiwell
authors.forename: S P
authors.initials: SP
authors.lastname: Granger
authors.forename: D C
authors.initials: DC
authors.lastname: Mitchell
authors.forename: J C
authors.initials: JC
authors.lastname: Rice
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008124:Locomotion; D008297:Male; D008591:Meningomyelocele / Q000150:complications* / Q000503:physiopathology* / Q000601:surgery; D008875:Middle Aged; D012445:Sacrococcygeal Region; D016896:Treatment Outcome