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[Orthopaedic Treatment for Patients with Myelomeningocele]
S Lebek1, U Seidel2, M Damerau3
1CMSC, Kinder- und Neuroorthopädie, Charité - Universitätsmedizin Berlin.
Insights
Orthopaedic care for children with myelomeningocele (MMC) focuses on preserving function and independence. Treatment evolves with age, utilizing orthoses and surgery to prevent deformities and support mobility.
Area of Science:
- Orthopaedics
- Developmental Pediatrics
- Rehabilitation Medicine
Context:
- Decreasing incidence of myelomeningocele (MMC) due to prenatal diagnostics and folic acid prophylaxis.
- Increasing lifespan of individuals with MMC necessitates long-term orthopaedic care.
- Focus shifts from birth defect management to functional preservation and independence.
Purpose:
- To review current knowledge and approaches in orthopaedic care for children with MMC.
- To outline a life-stage-specific treatment concept for functional improvement and preservation.
- To emphasize the role of orthoses and surgical interventions in managing MMC-related musculoskeletal issues.
Summary:
- Early intervention (0-2 years) with physiotherapy and orthoses supports mobility regardless of lesion level.
- Treatment is individualized from 2 years onward, considering muscle strength, deformities, comorbidities, and motivation.
- Orthotic management and surgical interventions aim to prevent deformities, manage pathological fractures, and prevent pressure sores, promoting independence.
Impact:
- Optimized orthopaedic care enhances functional independence and quality of life for individuals with MMC.
- Proactive management of musculoskeletal deformities and complications is crucial for long-term well-being.
- This approach supports lifelong self-employment and participation in society.
Background:
Due to prenatal diagnostic and folic acid prophylaxis less children with myelomeningocele are now being born. But they become older and need increasingly more orthopaedic care. The orthopaedic care is aimed at the improvement or the preservation of function.
Method:
In this review the current knowledge from the literature and our approach are presented. This is done in the context of the functional aspects within certain periods of life. Treatment Concept: In the first two years of life, the mobility of MMC children is supported by physiotherapy and orthoses irrespective of the level of the lesion. Afterwards, the optimal orthoses are chosen depending on the muscle power, emerging bone deformities, associated CNS malformation, shunt revisions, obesity and limitations in perception as well as the child's motivation. At school age, it is paramount to encourage independence. Orthotic treatment should be continued as long as the children benefit from it. Orthopaedic operations serve the orthosis fitting and the avoidance of pressure sores. Pathological fractures are common. They should be rapidly recognised in order to avoid further bony deformities.
Conclusion:
The aim of any orthopaedic treatment consists of the avoidance of musculoskeletal deformities in order to support the patient's self employment.
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