Factors Affecting the Outcomes in Children Post-Myelomeningocoele Repair in Northeastern Peninsular Malaysia

ABSTRACT

Background: The present study aimed to evaluate the impact of multiple factors and outcomes (ambulatory function and sphincter function) on children with myelomeningocoele (MMC) following surgical repair. Method: A retrospective chart review of children that underwent surgery for MMC in the Hospital Universiti Sains Malaysia from 1 January 1990 to 31 December 2004 was conducted. Only those children who were followed-up for at least 18 months after the operation were included in the study. Results: A total of 42 children with MMC were included in the study. Approximately 79% of the MMC were located in the lumbosacral and sacral regions. Thirty (71.4%) of the children had hydrocephalus, and 28 (67.7%) had a cerebrospinal fluid (CSF) shunt inserted. An analysis of the association between the predictors of ambulatory status revealed that hydrocephalus (P = 0.013), the presence of a CSF shunt (P = 0.005), intact motor function at L3 and below (P < 0.001), and the presence of deep tendon reflexes (P < 0.001) were good factors of ambulatory status. Only 16.7% of the children did not have urinary or faecal incontinence. Hydrocephalus (P = 0.049) and low-level MMC (P = 0.028) were significantly associated with sphincter control. Conclusion: Multiple factors contributed to the outcomes in post-MMC repair children in terms of ambulation and sphincter function following a repair of MMC. The Spina Bifida Neurological Scale (SBNS) should be applied during the management of these children to identify neurological deterioration.