Related Experiment Video
Updated: Jul 5, 2025
Evaluation of Patients' Posture and Gait Profile After Lumbar Fusion Surgery by Video Rasterstereography and Treadmill Gait Analysis
Published on: March 23, 2019
Ambulation after in-utero fetoscopic or open neural tube defect repair: predictors for ambulation at 30 months
M Sanz Cortes1, R Corroenne1, M Pyarali1
1Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, USA.
Insights
Prenatal repair of open neural tube defects (ONTD) significantly improves a child's chance of walking independently by 30 months compared to postnatal repair. Key predictors include intact motor function and lower lesion level.
Area of Science:
- Pediatric Surgery
- Fetal Medicine
- Neurology
Background:
- Open neural tube defects (ONTD) are serious congenital conditions affecting the spinal cord.
- Surgical repair aims to improve neurological outcomes, including ambulation.
- Prenatal repair strategies have evolved, including fetoscopic and open hysterotomy methods.
Purpose of the Study:
- To compare ambulatory status in children with ONTD repaired prenatally (fetoscopic vs. open) versus postnatally.
- To identify predictors of independent ambulation at 30 months of age in children with ONTD.
Main Methods:
- Retrospective review of 161 children with ONTD who underwent either prenatal (n=110) or postnatal (n=51) repair.
- Ambulatory status assessed at 30 months; motor function evaluated at birth, 12 months, and via ultrasound.
- Logistic regression used to identify predictors of independent walking.
Main Results:
- Higher independent walking rates at 30 months for prenatal repair (51.8%) vs. postnatal repair (15.7%) (P < 0.01).
- No significant difference in ambulation between fetoscopic (52.1%) and open (51.4%) prenatal repair groups.
- Predictors of walking included intact motor function at birth and 12 months, lesion level below L2, and female gender.
Conclusions:
- Prenatal ONTD repair is associated with significantly better outcomes for independent ambulation at 30 months.
- Early indicators like lesion level and motor function predict ambulatory success in prenatally repaired infants.
- Findings support prenatal repair and inform parental counseling and therapy planning.
Objectives:
To compare the ambulatory status of a cohort of children who had undergone prenatal repair of an open neural tube defect (ONTD) using one of two different methods (fetoscopic or open hysterotomy) with that of a cohort who had undergone postnatal repair, and to identify the best predictors of ambulation at 30 months of age.
Methods:
This was a retrospective review of a cohort of children who underwent ONTD repair either prenatally (n = 110), by fetoscopic surgery (n = 73) or open hysterotomy surgery (n = 37), or postnatally (n = 51), in a single tertiary hospital between November 2011 and May 2023. The cohort comprised a consecutive sample of cases who had undergone ONTD repair in-utero following Management of Myelomeningocele Study (MOMS) trial criteria and cases who had undergone postnatal repair, meeting the same criteria, which were also followed up after birth at the same institution. Motor function assessment by ultrasound was recorded at referral, 6 weeks after prenatal repair, or after referral in postnatally repaired cases, and at the last ultrasound scan before delivery. Clinical examinations to assess motor function at birth and at 12 months were retrieved from records. Intact motor function was defined as first sacral myotome (S1) motor function. Ambulatory status data at each follow-up visit were collected. The proportion of children who were able to walk independently after 30 months of age was compared between those who had undergone fetoscopic vs open prenatal surgery and between prenatal (by either fetoscopic or open surgery) and postnatal ONTD repair. Logistic regression analyses were performed to identify predictors for independent ambulation.
Results:
After 30 months, the proportion of infants who were able to walk independently was higher in prenatally vs postnatally repaired cases (51.8% vs 15.7%, P < 0.01), and there was no difference between those with fetoscopic (52.1%) vs open (51.4%) prenatal repair (P = 0.66). In the prenatally repaired group, having intact motor function at 12 months (adjusted odds ratio (aOR), 9.14 (95% CI, 2.64-31.63), P < 0.01) and at birth (aOR, 4.50 (95% CI, 1.21-16.80), P = 0.02) were significant predictors of independent walking at 30 months; an anatomical level of lesion below L2 at referral (aOR, 1.83 (95% CI, 1.30-2.58), P = 0.01) and female gender (aOR, 3.51 (95% CI, 1.43-8.61), P < 0.01) were also predictive for this outcome.
Conclusions:
Prenatally repaired cases of ONTD have a better chance of being able to walk independently at 30 months than do those who undergo postnatal repair. In patients with prenatally repaired ONTD, ambulatory status at 30 months can be predicted by observing a low lesion level at referral (below L2) and intact motor function postnatally. These results have implications for parental counseling and planning for supportive therapy in pregnancies affected by ONTD. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.
