Prognosis

Studies of children with prenatally diagnosed myelomeningocele suggest that less severe ventriculomegaly and a lower anatomic level of lesion on prenatal ultrasonograms predict better developmental outcomes in childhood. Aggressive treatment with closure in the neonatal period leads to survival in most cases of spina bifida, and aggressive shunting of hydrocephalus can permit the retention of near-normal intelligence in the majority of patients.

 The ability to ambulate depends on, and directly correlates with, the functional sensorimotor level.
Studies have shown that approximately 50-60% of young adult patients ambulate household or community distances, with about 20% of these patients using some orthotic or assistive device. The other 50% of patients use wheelchairs as their primary form of mobility. Approximately 20% of these individuals ambulate with orthotics and assistive devices as a form of therapeutic exercise.

 Several studies have shown that ambulation in patients with myelomeningocele is related to the strength of certain key muscles, including the iliopsoas, gluteus medius, hamstrings, and/or quadriceps. Gluteus medius strength was the best predictor of a need for gait aids and orthoses.

 Maximal ability to ambulate usually is achieved by the time the child reaches age 8-9 years. The ability to ambulate tends to decline in the second decade of life because of increased body dimensions and higher energy requirements. Lower-extremity muscle deterioration also may play a role.

 Except for sphincter control, independence in activities of daily living is likely for children born with myelomeningocele without hydrocephalus

 Studies report 40-85% achievement of bladder continence 50-85% achievement of bowel continence Approximately 25% of patients are continent of both bowel and bladder

Mortality
Survival and degree of neurologic impairment depend on the level of the spinal segment involved, the severity of the lesion, and extent of associated abnormalities Mortality rate for untreated infants : 90-100% Likelihood that an untreated 2-month-old infant lives up to 7 years: 28%

Mortality
Survival rates improves with the introduction of antibiotics & developments in the neurosurgical treatment of hydrocephalus Renal failure leading cause of death in patients with myelomeningocoele after 1st year of life Long-term survival into adulthood & advanced age is now common with aggressive treatment & an interdisciplinary clinical approach

RECENT DEVELOPMENTS IN SPINA BIFIDA

STEM CELL RESEARCH
Neural stem cells delivered in animal spinal cord have populated damaged areas of the SC and produced substances that protected the local tissue Stem cells were used to recreate specialized muscle & epithelial cells of the bladder in mice

RECENT DEVELOPMENTS IN SPINA BIFIDA

GENE COMPONENT AS RISK FACTOR FOR SPINA BIFIDA
Three mutations in the VANGL1 gene

KYPHECTOMY IN CHILDREN WITH MENINGOMYELOCELE

Kyphectomy & posterior spinal fusion and instrumentation with the Warner & Fackler technique allow correction and maintencae of sagittal alignment

RECENT DEVELOPMENTS IN SPINA BIFIDA

LOW LEVEL LASER THERAPY AS TREATMENT ON IMMEDIATE POST-MENINGOMYELOCELE REPAIR IN NEWBORNS
Showed significant decline in dehiscence of the surgical wounds in neonates

EXERCISE STUDIES
Upper extremity exercise device GameCycle benefited mobility-impaired spina bifida teens by improving oxygen uptake by all but one of the teens