Abstract
A follow-up from five to ten years of 40 patients treated by laminectomy for increasing neurological changes associated with spina bifida occulta is reported. The purpose of surgery has been to prevent further deterioration. 17 patients have improved and in a further 6 there is a possibility of some minor degree of improvement, 1 case has deteriorated subsequently, and the remainder are unchanged. Criteria for laminectomy were abnormality of gait associated with progressive neurological deficit or incontinence, X-ray evidence of a laminal deficit of a greater degree than only of the first sacral neural arch, and myelographic evidence of abnormality or of a low-placed conus medullaris. Among the causes for the neurological changes were found diastematomyelia, intramedullary dermoid, cauda equina adhesions, ectopic dorsal nerve roots, and subcutaneous lumbosacral lipoma with a deep connection. It is dangerous to remove the subcutaneous lipoma related to a spina bifida unless the surgeon is prepared to explore the cauda equina at the same time.
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