Abstract
Two series of liveborn spina-bifida cases (myelocele and meningocele) in South Wales, an unoperated series of 290 cases born between 1956 and 1962 (with 54 survivors in 1968) and an aggresively treated series of 113 cases born between 1964 and 1966 (with 57 survivors in 1973), were compared to assess the effect of surgery on survival and quality of survival. Significantly more cases survived as a result of the modern surgical approach, but these survivors were significantly more handicapped. Of 100 liveborn cases only 17 can expect to survive into the teens without operation, with 8 minimally handicapped and 5 dependent on wheelchairs; but with aggressive operative treatment 50 out of 100 can expect to survive, with 15 minimally handicapped and 27 dependent on wheelchairs. The operated cases were significantly more mentally handicapped, probably because of hydrocephalus. It is concluded that these results must influence future treatment policy and should spur effort toward antenatal detection of spina bifida.
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