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Hip instability in myelomeningocele. 158 patients followed for 15 years
1Department of Orthopedics, Karolinska Hospital, Stockholm, Sweden.
Insights
Hip dislocation is common in myelomeningocele patients, particularly with higher spinal cord involvement. Early assessment and understanding of risk factors are crucial for managing hip instability in these children.
Area of Science:
- Orthopedics
- Pediatric Neurology
- Developmental Biology
Background:
- Myelomeningocele is a complex congenital condition affecting spinal cord development.
- Hip instability, including subluxation and dislocation, is a frequent complication in myelomeningocele.
- Understanding the relationship between neurologic level and hip development is critical for patient management.
Purpose of the Study:
- To determine the prevalence of hip dislocation and subluxation at birth and during childhood in patients with myelomeningocele.
- To investigate the correlation between neurologic level and the incidence of hip dislocation and subluxation.
- To identify risk factors, such as spasticity, associated with hip dislocation in this population.
Main Methods:
- Retrospective analysis of 158 patients diagnosed with myelomeningocele.
- Assessment of hip status (dislocation, subluxation) at birth, 2 years, and 15 years of age.
- Correlation of hip abnormalities with the patient's neurologic level and presence of spasticity.
Main Results:
- 10% of neonates with myelomeningocele had hip dislocation at birth.
- Hip dislocation incidence increased with higher neurologic levels (thoracic to L1-2: 8-26%; L3-4: 25%).
- Subluxation prevalence varied by neurologic level, reaching nearly 50% in L3-4 and 20% in L5/sacral levels. Spasticity was linked to dislocation above L3.
Conclusions:
- Neurologic level significantly influences the risk and type of hip abnormalities in myelomeningocele.
- Hip dislocation risk appears minimal below the L4 neurologic level.
- Spasticity is a key factor promoting hip dislocation in patients with myelomeningocele above L3.
Abstract:
In 158 patients with myelomeningocele, the prevalence of hip dislocation at birth and subluxation or dislocation of unoperated on hips at 2 and 15 years of age were assessed. In neonates examined during the first 10 weeks of life, 10 percent of the hips were dislocated. In children with a thoracic or L1-2 neurologic level, the cumulative incidence of dislocated hips increased from 8 to 26 percent and subluxations from 33 to 45 percent. In children with L3 and L4 levels, one fourth of the hips had dislocations and nearly half subluxations. At L5 and the sacral motor level, dislocations did not occur, but one fifth of the hips had subluxations. Children with L3 or L4 neurologic levels had bilateral hip dislocation at an earlier age than those with higher levels of paralysis. There appears to be no risk of developing hip dislocation at neurologic levels below L4, and spasticity promotes hip dislocation above L3.
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