PRENATAL SPINAL EVALUATION AND FUNCTIONAL OUTCOME OF PATIENTS BORN WITH MYELOMENINGOCELE - INFORMATION FOR IMPROVED PRENATAL COUNSELING ANDOUTCOME PREDICTION

Objective: Prenatal ultrasonography can localize the level of the spin al cord malformation, allowing prediction of the potential postnatal n eurological deficit and functional prognosis, Methods: This study has two evaluations: (a) a retrospective prenatal review of 26 fetuses wit h spinal dysraphism (1987-1991), and (b) a follow-up descriptive study of patients (1971-1981) who underwent closure of the spinal lesion an d ventricular shunting in the neonatal period. Results: Prenatal ultra sound evaluation enabled the accurate definition of the last intact ve rtebral level which allows separation of fetuses into three functional groups (last intact level L2, L3-4, L5-sacral). Patterns of ambulatio n, urinary and bowel continence, and school performance vary according to level of spinal lesion and the neurological deficit, The need for ventricular shunts, the incidence of other spinal malformations and su rgical interventions did not vary with the level of the spinal lesion. Conclusions: The functional outcome for patients with myelomeningocel e is variable; however, distinct patterns emerge based on the level of spinal dysraphism and the resultant neurological deficit. By relating the level of the fetal spinal lesion to outcome data, more precise fu nctional prognoses can be given to families.