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Clinical Orthopaedics and Related Research®

, Volume 469, Issue 5, pp 1246–1252 | Cite as

Adult Consequences of Spina Bifida: A Cohort Study

  • James W. Roach
  • Barbara F. Short
  • Hanna M. Saltzman
Symposium: Myelomeningocele

Abstract

Background

Patients with spina bifida potentially experience social isolation with limited employment opportunities and restriction of independent living, neurologic and intellectual impairment, and orthopaedic and urologic consequences of their condition. However, the degree of disability as these individuals age into adulthood has not been completely delineated.

Questions/purpose

In adults with spina bifida we determined the cause of death for those who had died, IQ, level of education, work history, independent living status, physical disabilities, and urologic status; we then identified surgical procedures that led to better adult function.

Methods

We retrospectively reviewed 84 individuals with myelomeningocele, examining social, cognitive, and physical disabilities. The minimum age at followup was 20 years (mean, 31 years; range, 20–64 years).

Results

Forty-two percent had normal IQs. Seventy percent never needed a neurosurgical shunt and those without shunts had higher IQs. Forty-four percent had regular education and 8% achieved college degrees. Fifty-six percent were unemployed. Thirty percent lived independently. Twenty-three percent were either married or divorced with nine normal offspring. Eighty-five percent dressed themselves, 65% shopped independently, 54% drove. Thirty-one percent were at the thoracic neurologic level (all used wheelchairs), 12% were at L1–L3 (all used a wheelchair except one), 33% were at L4–L5 (78% used a wheelchair at least part-time), and 24% were at S1 and below (all walked). Fifty-four percent experienced decubiti and as a consequence, four required major extremity amputations. Spinal fusions protected sitting balance, but hip surgery did not produce congruent hips and occasionally resulted in debilitating stiffness. Pressure sores resulted in partial foot amputations despite plantigrade feet.

Conclusions

Our observations confirm the consequences associated with the physical and cognitive disabilities of patients with spina bifida. Many of these consequences can likely be mitigated by modern multidisciplinary care and special education to increase independence.

Level of Evidence

Level IV, observational study. See Guidelines for Authors for a complete description of levels of evidence.

Keywords

Spina Bifida Pressure Sore Pelvic Obliquity Bladder Control Posterior Tibialis Tendon 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

We thank Adenia Spencer, OTR, for her assistance in assessing the study subjects’ activities of daily living and Anne Morton, PhD, for the psychologic testing.

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Copyright information

© The Association of Bone and Joint Surgeons® 2010

Authors and Affiliations

  • James W. Roach
    • 1
    • 2
  • Barbara F. Short
    • 3
  • Hanna M. Saltzman
    • 4
    • 5
  1. 1.Department of OrthopedicsUniversity of Pittsburgh, Children’s Hospital of PittsburghPittsburghUSA
  2. 2.Department of OrthopaedicsUniversity of Utah, Shriners Hospitals for ChildrenSalt Lake CityUSA
  3. 3.Department of Pediatric OrthopedicsTexas Scottish Rite HospitalDallasUSA
  4. 4.Department of OrthopaedicsUniversity of UtahSalt Lake CityUSA
  5. 5.Department of Pediatric OrthopaedicsShriners Hospitals for ChildrenSalt Lake CityUSA

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