title: Adult consequences of spina bifida: a cohort study.
abstract: BACKGROUND
  Patients with spina bifida potentially experience social isolation with limited employment opportunities and restriction of independent living, neurologic and intellectual impairment, and orthopaedic and urologic consequences of their condition. However, the degree of disability as these individuals age into adulthood has not been completely delineated.
  
  
  OBJECTIVE
  In adults with spina bifida we determined the cause of death for those who had died, IQ, level of education, work history, independent living status, physical disabilities, and urologic status; we then identified surgical procedures that led to better adult function.
  
  
  METHODS
  We retrospectively reviewed 84 individuals with myelomeningocele, examining social, cognitive, and physical disabilities. The minimum age at followup was 20 years (mean, 31 years; range, 20-64 years).
  
  
  RESULTS
  Forty-two percent had normal IQs. Seventy percent never needed a neurosurgical shunt and those without shunts had higher IQs. Forty-four percent had regular education and 8% achieved college degrees. Fifty-six percent were unemployed. Thirty percent lived independently. Twenty-three percent were either married or divorced with nine normal offspring. Eighty-five percent dressed themselves, 65% shopped independently, 54% drove. Thirty-one percent were at the thoracic neurologic level (all used wheelchairs), 12% were at L1-L3 (all used a wheelchair except one), 33% were at L4-L5 (78% used a wheelchair at least part-time), and 24% were at S1 and below (all walked). Fifty-four percent experienced decubiti and as a consequence, four required major extremity amputations. Spinal fusions protected sitting balance, but hip surgery did not produce congruent hips and occasionally resulted in debilitating stiffness. Pressure sores resulted in partial foot amputations despite plantigrade feet.
  
  
  CONCLUSIONS
  Our observations confirm the consequences associated with the physical and cognitive disabilities of patients with spina bifida. Many of these consequences can likely be mitigated by modern multidisciplinary care and special education to increase independence.
authors.affiliation: Department of Orthopedics, University of Pittsburgh, Children's Hospital of Pittsburgh, 4401 Penn Avenue, Faculty Pavilion, 4th Floor, Pittsburgh, PA 15224, USA. roachjw@upmc.edu
authors.forename: James W
authors.initials: JW
authors.lastname: Roach
authors.forename: Barbara F
authors.initials: BF
authors.lastname: Short
authors.forename: Hanna M
authors.initials: HM
authors.lastname: Saltzman
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D002423:Cause of Death; D002557:Cerebrospinal Fluid Shunts; D003071:Cognition; D015331:Cohort Studies; D004185:Disability Evaluation; D004522:Educational Status; D004651:Employment; D006801:Humans; D057187:Independent Living; D007360:Intelligence; D007361:Intelligence Tests; D008591:Meningomyelocele / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology / Q000523:psychology / Q000601:surgery; D008875:Middle Aged; D020127:Recovery of Function; D012189:Retrospective Studies; D012919:Social Behavior; D012934:Social Isolation; D016135:Spinal Dysraphism / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology / Q000523:psychology / Q000601:surgery; D011795:Surveys and Questionnaires; D013781:Texas; D016896:Treatment Outcome; D014554:Urination; D055815:Young Adult