Abstract
Introduction: The incidence of scoliosis in patients with myelomeningocele has been reported to be as high as 80 to 90% in some studies. However these studies included patients with both congenital and developmental curves. The purpose of this study is to identify clinical and radiological factors, which may predict the development of scoliosis in patients with myelomeningocele.
Methods: A retrospective review of the charts and radiographs of all patients with myelomeningocele seen in our clinic between 1990 and 1995 was performed. Selection criteria for the study included: a diagnosis of myelo-meningocele or lipomeningocele, age greater than 10 years, serial documentation of motor power testing, and a radiographic documentation of spinal deformity primarily in the coronal plane.
Statistical analysis was performed to obtain predictive values, specificity and sensitivity for each of the following factors: clinical motor level, functional status, motor asymmetry and hip instability.
Radiographs were examined to obtain the last intact laminar arch in these patients. The relationship between the last intact laminar arch and scoliosis was evaluated.
Results: 141 patients satisfied the inclusion criteria. Seventy-four patients (53%) developed scoliosis. The mean follow-up was 9.4 years (range 3–30 years). The average age of the patient population was 19 (range 10–42 years). Forty-three patients developed scoliosis before nine years of age. New curves continued to develop until 15 years of age. Curves less than 20° often resolved. Clinical motor level, functional status, motor asymmetry and the last intact laminar arch were all found to be predictive for scoliosis in these patients. The presence of spasticity and hip instability had no definite influence on the development of scoliosis.
Conclusion: The term scoliosis should be reserved for curves greater than 20° in patients with myelomeningocele. New curves may continue to develop until 15 years of age. The last laminar arch is a useful early indicator of scoliosis in these patients.
Abstracts prepared by Mr J. Dorgan. Correspondence should be addressed to him at the Royal Liverpool Children’s Hospital, Alder Hey, Eaton Road, Liverpool L12 2AP, UK
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