Analysis of the Relationship between Deformity and Activity of Daily Living According to the Level of Neurologic Deficit in Myelodysplasia - Part Two: Lipomeningocele - / 대한정형외과학회잡지

PURPOSE: To clarify the relationship between the level of neurologic deficit and deformity of the lower extremity and also the ambulatory status. MATERIALS AND METHODS: We performed retrograde analysis on 79 patients older than 30months with lipomeningocele. All of the patients were classified according to the level of neurologic functional motor deficit. There were 52 males and 27 females patients. Average age was 6 years and 8 months. RESULTS: There was only one patient in the upper lumbar (L1-L2) motor level deficit. He was a non ambulator. Among the 26 with lower lumbar (L3-L5) deficit, 6 were household ambulators, 20 were community ambulators; 2 had hip deformities and 22 had foot deformities. Among the 48 patients with sacral (S1-S3) deficit, all were community ambulators; 3 had hip deformities and 27 had foot deformities. In 4 patients who showed normal motor function, all were community ambulators without any deformity. CONCLUSION: In lipomeningocele, patients who had a functional motor deficit above L4 level showed poor ambulatory status. However, those below L4 level showed good ambulation, and in cases with the L4-5 motor level deficit, we were able to improve the ambulatory status after correction of the deformities of the lower extremity.

Electrophysiologic Study of Spina Bifida Patients

Electrophysiologic study including needle electromyograpy(EMG) was done in 66 patients with spina bifida who were referred to EMG laboratory. We have classified neurological impairments of spina bifida patients according to electrodiagnostic findings and the electrophysiologic study findings were compared with Magnetic Resonance Image(MRI) findings, and manual muscle test findings. Also electrophysiologic study findings were compared with urodynamic study(UDS) finding for the evaluation of neurogenic bladder in the same subjects. 55% of spina bifida patients had cauda equina lesions electrophysiologically and the most commonly involved, root was L5, and the next was S1. 42% of the subjects were normal electrophysiologically. 61% of patients with abnormal MRI findings had normal EMG findings. EMG findings did not correlated well with manual muscle tests in 44% of the subjects. Also in 44% of subjects, the electrophysiologic study was did not agree with urodynamic study findings. In conclusion, we asserts that cauda equina lesion is a most common lesion in spina bifida patients and electrophysiologic study is superior than MRI or manual muscle test in detecting neurologic deficit of spina bifida patients. However, electrophysiologic study alone offers less accurate information than urodynamic study for the evaluation of neurogenic bladder in spina bifida patients.