Ambulation in patients with myelomeningocele: A 12-year follow-up

Factors determining change in ambulatory status were studied over a 12-year observation time in 60 ambulating patients with myelomeningocele. There we re 26 female and 34 male subjects with a median age of 22 years (range, 12- 54). We used the method of Lindseth to define the neurologic level of the l esion and classified walking ability according to the criteria of Hoffer. T he prevalence of spasticity and spine and lower-limb deformities was assess ed. Orthopedic and neurosurgical interventions and other medical events wer e registered, as well as occurrence of pressure sores, musculoskeletal pain , and use of orthoses. There were 19 patients with downward transitions in ambulatory level during the follow-up time. Factors explaining deterioratio n in these 19 patients included deterioration of the neurologic level of le sion, spasticity, knee and hip flexion contractures, low-back pain, lack of motivation, as well as those of major medical events like stroke,recurrent septicemia, lower limb edema, and invasive surgical interventions.