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Trends in incidence and long-term outcomes of myelomeningocele in British Columbia

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Abstract

Purpose

Myelomeningocele is typically a disabling condition that results in neurologic, orthopedic, and urologic morbidity. The aim of this study was to examine the trends over time in both incidence and outcomes of myelomeningocele (MMC) in British Columbia (BC).

Methods

A retrospective chart review was performed of all children with MMC followed in the British Columbia Children’s Hospital (BCCH) Spinal Cord Clinic between 1971 and 2016. The incidence of new MMC cases and the long-term outcomes of MMC were compared between two 10-year cohorts. The first cohort comprised children born with MMC between 1971 and 1981, and the second cohort comprised children born with MMC between 1996 and 2006.

Results

A total of 309 children with MMC were followed in the BCCH Spinal Cord Clinic between 1971 and 2016. There were 101 and 46 children with MMC in the two-time cohorts, respectively. Between the earlier and later cohorts, there was a significant difference in the following: MMC incidence [2.5/10,000 births vs 1.1/10,000 births, respectively (p = 0.0002)], mortality [18 vs 0% (p = 0.0009)], and the proportion of cases repaired in under 48 h [56 vs 98% (p < 0.0001)]. For surviving children, the proportion of children attending special classes was significantly different between the earlier and later cohorts [16 vs 46%, respectively (p = 0.0002)], whereas all other outcome measures, including the proportion with hydrocephalus, kyphoscoliosis, Chiari II surgery, bowel and bladder continence, recreation participation, obesity, and ambulation, were not significantly different.

Conclusions

In BC, the incidence of new cases of MMC has decreased between 1971 and 2016, while the probability of survival for these patients has increased. Despite earlier and more universal post-natal repair, long-term outcomes have not improved significantly over time. Future research should focus on developing ways of reducing disability and improving quality of life for MMC patients and their families.

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Acknowledgements

We thank Dr. Doug Cochrane and Dr. Patrick McDonald for thoughtfully reviewing the final draft of this project.

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Authors and Affiliations

  1. University of British Columbia, Vancouver, BC, Canada

    Taylor North, Alexander Cheong, Paul Steinbok & Julia AE Radic

  2. Division of Pediatric Neurosurgery, British Columbia Children’s Hospital (BCCH), 4480 Oak Street, Rm K3-167, Vancouver, BC, V6H 3V4, Canada

    Taylor North, Alexander Cheong, Paul Steinbok & Julia AE Radic

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  1. Taylor North
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  2. Alexander Cheong
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  4. Julia AE Radic
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Correspondence to Taylor North.

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Ethics approval

The study was approved by the Children’s and Women’s Health Centre of British Columbia Research Ethics Boards, approval number: H17-00277.

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The authors have nothing to disclose.

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

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North, T., Cheong, A., Steinbok, P. et al. Trends in incidence and long-term outcomes of myelomeningocele in British Columbia. Childs Nerv Syst 34, 717–724 (2018). https://doi.org/10.1007/s00381-017-3685-6

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  • DOI: https://doi.org/10.1007/s00381-017-3685-6

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