Orthopaedic management of the lower extremities in spina bifida

Myelodysplasia is a multisystem disease that requires a multidisciplinary approach. The orthopaedist is often the first to identify a changing neurologic picture or deformity and must work closely with neurosurgical colleagues to identify correctable neurologic lesions. The role of the orthopaedist begins at the birth of the child with spina bifida. At this time, the level of neurologic involvement can be determined. Education of the parents can then begin by outlining the expected ambulatory potential of the child, and predicting deformities or complications that might be anticipated depending on the level of neurologic involvement. The orthopaedist must also emphasize the extreme importance of neurosurgical care in preventing deterioration of neurologic function, so that goals for ambulation and musculoskeletal function can be achieved. As the child gets older, motor milestones paralleling those of a normal child should be sought with use of a corner chair or sitting device, followed by the use of a standing frame if needed. If appropriate, the child will then progress to full-control braces, with weaning as determined by neurologic level of involvement . Long-term mobility may be achieved by bracing or by the use of a wheelchair. A realistic approach must be taken in goal-setting, so that a child is not pressured to achieve unrealistic goals yet is enabled to achieve full functional capacity.