This article presents a radiologic review of the spectrum of acquired and congenital orthopedic abnormalities found in patients with myelomeningocele. These abnormalities are caused predominantly by muscle imbalance, paralysis, and decreased sensation in the lower extremity. Iatrogenic injury, such as a postoperative tethered cord, may also cause bone abnormalities. Selected images were obtained from more than 800 children. Important entities presented include spinal curvatures such as kyphosis, scoliosis, and lordosis; subluxation and dislocation of the hip, coxa valga, contractures of the hip, and femoral torsion; knee deformities; rotational abnormalities of the lower extremity and external and internal torsion; ankle and foot abnormalities such as ankle valgus, calcaneus foot, congenital vertical talus (rocker-bottom deformity), and talipes equinovarus; and metaphyseal, diaphyseal, and physeal fractures.
RadioGraphics, Vol 12, 1155-1173 1992 MA Westcott, MC Dynes, EM Remer, JS Donaldson and LS Dias Department of Radiology, Northwestern Memorial Hospital, Northwestern University Medical School, Chicago, IL.

User and Orthotist Perspectives Adrian A. Polliack, PhD Sarah Elliot Samuel E. Landsberger, ScD Donald R. McNeal, PhD Carin Caves, BS, CO JPO 2001 Vol. 13, Num. 4 pp. 123-129
Although there are a host of positive benefits to using orthoses during childhood, the two major reasons are to improve independent function and prevent deformities. 1-4 The latter is particularly important in children. Because bone tissue is more malleable and the epiphysial plates are not ossified, bone and joint deformities can develop if forces are unbalanced or abnormal. Protective stabilization of the lower limb is thus often required to decrease skeletal changes resulting from neuromuscular dysfunction.

Goals of orthopaedic management are

• Straight spine, legs and feet
• Mobile hips
• Pull-to or swing through gait
• Maximum possible sefl sufficiency

West J Med 121:281-291 1974

Core Curriculum
Objectives
1. Define myelodysplasia, and list two separate clinical presentations of myelodysplasia
2. Describe the relationship of myelomeningocele with anencephaly
3. Describe the range of clinical severity in patients with myelomeningocele
4. Discuss the relationship of orthopaedic problems accompanying myelomeningocele to neurologic level
5. Discuss the prognosis for ambulation in patients with spina bifida
6. Define a dietary supplement of proven effectiveness in reducing birth rates of myelodysplasia
7. Describe the relationship of latex allergy and myelodysplasia
8. Describe the clinical presentation of spinal dysraphism without spina bifida aperta
Discussion points
1. Is upper limb function normal in patients with myelomeningocele?
2. Why is a multispecialty clinic setting preferred for management of children with myelomengocele?

Author: Kat Kolaski, MD, Assistant Professor, Departments of Orthopedics and Pediatrics, Wake Forest University School of Medicine
Myelomeningocele is a complex congenital spinal anomaly that causes varying degrees of spinal cord malformation, or myelodysplasia. It is commonly referred to as spina bifida and is classified as a defect of the neural tube (ie, the embryonic structure that develops into the spinal cord and brain). Patients with myelomeningocele present with a spectrum of impairments, but the primary functional deficits are lower limb paralysis and sensory loss, bladder and bowel dysfunction, and cognitive dysfunction. Medical, surgical, and rehabilitation issues arise in the patient with myelomeningocele from birth through adulthood.
Synonyms and related keywords: open spinal dysraphism, neural tube defect, myelodysplasia, spina bifida, spina bifida cystica, spina bifida aperta, open spina bifida

scoliosis in myelomenigocele may have a multifactorial etiology:
- idiopathic causes;
- myelomeningocele structural defect;
- congenital defects
- paralytic etiology;
- 15-20% of children who have myelomeningocele have congenital vertebral abnormalities in addition to congenital scoliosis;
- over-all incidence of scoliosis in pts who have thoracic-level lesion is 85%;
- all children who are born with an osseous dysraphism at level of T12 or higher, are at risk for the development of a severe scoliotic deformity for which arthrodesis is needed;

JBJS A 1990 72: 626-630 Beaty & Canale (full text)

- Discussion of Myelodysplasia
- Spinal Deformities
- Lower Extremity
- hip in myelomeningocele:
- fractures:
- myelodysplastic knee:
- foot deformities in myelomeningocele:

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("spina bifida"[All Fields] OR (("meningomyelocele"[TIAB] NOT Medline[SB]) OR "meningomyelocele"[MeSH Terms] OR myelomeningocele[Text Word]) OR (("myelodysplastic syndromes"[TIAB] NOT Medline[SB]) OR "myelodysplastic syndromes"[MeSH Terms] OR myelodysplasia[Text Word]) OR "spinal dysraphism"[All Fields]) AND ("BMC Musculoskelet Disord"[Journal] OR "Bull Hosp Jt Dis"[Journal] OR "Bull Hosp Jt Dis Orthop Inst"[Journal] OR "Clin Orthop"[Journal] OR "Clin Orthop Relat Res"[Journal] OR "Contemp Orthop"[Journal] OR "Curr Opin Orthop"[Journal] OR "Curr Orthop"[Journal] OR "Curr Pract Orthop Surg"[Journal] OR "Orthopade"[Journal] OR "Eur Spine J"[Journal] OR "Foot Ankle"[Journal] OR "Acta Orthop"[Journal] OR "Acta Orthop Suppl"[Journal] OR "Acta Orthop Belg"[Journal] OR "Acta Orthop Traumatol Turc"[Journal] OR "Acta Orthop Scand"[Journal] OR "Acta Orthop Scand Suppl"[Journal] OR "Aktuelle Probl Chir Orthop"[Journal] OR "Am J Knee Surg"[Journal] OR "Am J Orthop Surg"[Journal] OR "Am J Orthop"[Journal] OR "Am J Orthop"[Journal] OR "Arch Orthop Trauma Surg"[Journal] OR "Arch Orthop Trauma Surg"[Journal] OR "Arthroscopy"[Journal] OR "Foot Ankle Int"[Journal] OR "Foot Ankle Clin"[Journal] OR "Gait Posture"[Journal] OR "Hand Clin"[Journal] OR "Hip"[Journal] OR "Instr Course Lect"[Journal] OR "Int Orthop"[Journal] OR "Iowa Orthop J"[Journal] OR "Ital J Orthop Traumatol Suppl"[Journal] OR "Joint Bone Spine"[Journal] OR "J Arthroplasty"[Journal] OR "J Bone Joint Surg Am"[Journal] OR "J Bone Joint Surg Br"[Journal] OR "J Knee Surg"[Journal] OR "J Orthop Res"[Journal] OR "J Orthop Sci"[Journal] OR "J Orthop Surg (Hong Kong)"[Journal] OR "J Orthop Trauma"[Journal] OR "J Pediatr Orthop B"[Journal] OR "J Pediatr Orthop"[Journal] OR "J Shoulder Elbow Surg"[Journal] OR "J Surg Orthop Adv"[Journal] OR "J Am Acad Orthop Surg"[Journal] OR "J South Orthop Assoc"[Journal] OR "Knee"[Journal] OR "Knee Surg Sports Traumatol Arthrosc"[Journal] OR "Minerva Ortop"[Journal] OR "Mod Trends Orthop"[Journal] OR "Musculoskeletal Care"[Journal] OR "Oper Orthop Traumatol"[Journal] OR "Orthop Rev"[Journal] OR "Orthop Clin North Am"[Journal] OR "Orthopedics"[Journal] OR "Rev Chir Orthop Reparatrice Appar Mot"[Journal] OR "Semin Arthroplasty"[Journal] OR "Spine"[Journal] OR "Spine J"[Journal] OR "Sports Med Arthrosc"[Journal])

Spinal dysraphism can be classified as closed forms or open forms, which include myelocele, meningocele, and myelomeningocele. These open forms are often associated with hydrocephalus and Arnold-Chiari malformation type II and may be classified as spina bifida aperta. Von Recklinghausen (1886) gave a detailed account of spina bifida cystica (aperta). Spina bifida is described in the medieval literature, although the condition was recognized even earlier.
Synonyms and related keywords: neural tube defects, NTD, open neural tube defects, ONTD, myelocele, meningocele, myelomeningocele, spina bifida cystica, closed neural tube defects, spina bifida occulta, tethered cord, filum terminal syndrome, cord traction syndrome, diastematomyelia, diplomyelia

We report the results of a prospective study of the surgical release of 45 knee flexion contractures in 28 patients with myelomeningocele... We conclude that surgical release of knee flexion contractures in myelomeningocele improves gait in all children who walk, particularly those with low lumbar lesions. Recurrence of knee flexion contractures after surgical release is most common in those with thoracic lesions who do not achieve independent walking.
JBJS B 1996 78 B 912-6

Myelomeningocele is the most complex congenital multi-system disorder, which affects not only the central nervous system, but the kidneys and bowel, as well as the musculoskeletal system.
Journal of Prosthetics & Orthotics 1990 Vol. 2, Num. 4 pp. 263-273

Medscape News 2001: Hairy Patches and Twisted Feet: What's New in Pediatrics?
Carl St. Remy, MD Introduction What's new in pediatric orthopaedic diagnostics and treatment techniques? New research on the use of ultrasonographic screening for spinal dysraphism, nonsurgical management of clubfoot deformity, and off-label use of pamidronate for the treatment of osteogenesis imperfecta (OI) was presented at the 68th Annual Meeting of the American Academy of Orthopaedic Surgeons.

most common foot deformity in myelomeningocele;
- teratological club-foot deformity in children w/ myelomeningocele is often more severe and more rigid than seen in congenital club foot deformity;
- secondary foot deformities may also develop as a result of muscle imbalance and/or spasticity