RESUMEN
Numerous studies in the past have addressed the issue of ambulation in children with spina bifida. Some researchers have demonstrated the significant benefits of walking in patients with myelomeningocele. Those who walked as children had fewer fractures and pressure sores compared to those who used a wheelchair from early in life. They also were more independent and had a better ability to transfer. In order to encourage the achievement and maintenance of ambulatory skills, it is necessary to have realistic expectations for a patient with a given neurosegmental level. In order to guide those expectations one needs to know the patterns of ambulation. Due to the improvements in orthotic design, orthopaedic and neurosurgical procedures and possible change in outcome, there is a need to re-define the patterns of ambulation among myelomeningocele patients and compare those to the previously reported results. The study is a cross-sectional restrospective analysis of the ambulatory status of patients attending our myelomeningocele clinic at Blythedale Children's Hospital in Valhalla, NewYork over a one-year period from January to December of 1999. Patients and/or their parents have been interviewed over the telephone and the ambulation data was obtained. The clinic and hospital charts were reviewed. The neurological level was assigned based on the last neurological examination. Seventy-four patients were included in the study; 18% of patients had their lesions at the thoracic level, 22% at high-lumbar [L1-2], 12% at mid-lumbar [L3], 38% at low-lumbar [L4-5] and 10% at the sacral level. In the thoracic level group 15% of the patients were community ambulators, in the high-lumbar group 0%, in the mid-lumbar 33%, in the low-lumbar 71% and in the sacral level group 88%. The mean age for ambulation commencement for patients with thoracic level lesions was 5.7 years, for high-lumbar 4.1 years, for mid-lumbar 3.8 years, for low-lumbar 3.0 years and with sacral level lesions 1.2 years. Sixty percent of the thoracic level patients, 100% of the patients at high-lumbar levels, 40% of patients at a mid-lumbar level, and 20% at low-lumbar levels and none at sacral levels have ceased ambulation. The mean age for ambulation cessation for patients with thoracic level lesions was 12 years, for high-lumbar 8.9 years, for mid-lumbar 15 years, and for low-lumbar 11.6 years. No patients with sacral level lesions who acquired ambulation skills stopped walking in our study. Our results have demonstrated that the overall pattern of acquisition and loss of ambulatory skills among myelomeningocele patients has not changed substantially in the past several years, despite various technical advances in this field