Article

The management of orthopedic problems in spina bifida has seen a dramatic change
over the past 10 years. The negative effects of spasticity, poor balance, and the
tethered cord syndrome on ambulatory function are better appreciated. There is
less emphasis on the hip radiograph and more emphasis on the function of the knee
and the prevention of knee pain. The importance of the hip abductor muscle and
its influence on gait and knee function has been realized. Important developments
in the treatment of spinal deformity include the use of pedicle screws which
allow better correction. The role of anterior-only spinal surgery has been
defined, which allows motion at the lumbo-sacral junction and has a lower
postoperative infection rate than posterior surgery. Functional outcome
assessments provide better feedback for surgeons and families in regards to which
patients may benefit most from surgery. Overall, the past 10 years has seen the
increased use of functional outcome measures such as Motion Analysis, oxygen
consumption, and patient-based outcome assessments rather than traditional
radiographic measures (e.g., hip dislocation or subluxation). This progress has
resulted in a better understanding of spina bifida and, more importantly,
improved outcomes for our patients. Additional research is likely to further
enhance outcomes by establishing additional evidence-based interventions.

Langue : ANGLAIS