SURGICAL ADVANCES IN THE MANAGEMENT OF DEFORMITIES OF THE SPINE AND LOWER LIMBS IN SPINA BIFIDA.

Abstract

Summary In the past the orthopaedic problems associated with spina bifida have often been disregarded and rehabilitation of these cases considered impractical. This paper describes the problems encountered in over 100 cases treated by the Orthopaedic Department of the Royal Children's Hospital in Melbourne. The cases have been classified into 4 groups depending on the extent of paralysis. The first group have high lesions with paralysis of the trunk and legs. These are largely aproblem of bracing and, except in neglected cases, offer little scope for surgery. The second and largest group are paraplegic but the psoas muscle is active. In these patients a wide range of surgical procedures for hip dislocation, hip contracture and transfer of the psoas tendon to the greater trochanter will often be required. In the fourth group where there is a combination of paralysis below the knee and gluteal paralysis, correction of foot deformities, their retention by tendon transfer and psoas transplant at the hip will all be part of the surgical programme. The final group with minimal or no paralysis rarely presents as an orthopaedic problem. Secondary deformities occurring in the spine, hip and knees often require considerable ingenuity in their correction. While most of the surgical procedures used in this series are well known, minor but important modifications have been found necessary to achieve success. The timing and planning of the rehabilitation programme is perhaps the most difficult task, and this is described in some detail. A great range of standard surgical procedures is available and with suitable modifications can produce successful results. These are described and the timing and selection ofthe best methods discussed.