Abstract

Background: Spinal dysraphism is common congenital cause of disability in children
encountered by pediatric neurosurgeon and is a significant public health problem. Open
type spina bifida is more common than closed one. Though most of these cases are
diagnosed at birth or at an early infancy, some may be discovered in older children or
in adults. Aim & Objective: Our aim is to study the incidence, clinical presentations,
and surgical outcome in spinal dysraphism patients. Clinically patients are assessed on
the basis of history, presenting symptoms and neurological examination.
Results: A total of 54 patients included in this study. The age ranged from 1day to 17
years. The incidence is high in females 57.40 % (n=31) than males 42.60 % (n=23). The
swelling over the middle of the back was most common manifestation present in
32(59.2%) cases out of total 54 cases. 8 patients (14.81%) had ruptured
myelomenigocele/ myelocele sac. The skin markers which occur in spina bifida occult
type like dermal sinus, Hypertrichosis, dimple of skin present in 3(5.55%), 2(3.70%),
1(1.85%) respectively. Craniospinal MRI was done in all patients for evaluation of
congenital anomalies associated with spinal dysraphism. All were having one or
multiple anomalies. Spina bifida aperta (37) was more common than bifida occulta
which is noted in17 patients. Most common finding is myelomeningocele in 33 (61.11%)
cases, myelocele 4 (7.47%). In closed type, lipomyelomeningocele 7(12.96%) was most
common finding, and meningocele 3(5.55%), lipomyelocele 2(3.70%), diastematomyelia
in 2((3.70%), dermal sinus 2(3.70%), spinal lipoma in one (1.85%) case.Most of the
patients associated with hydrocephalus require shunt surgery prior to the definitive
surgery.The post operative care is equally important to avoid complications and for
better outcome. Electro myographic studies and urodynamic studies are required to
assess the sphincteric outcome following surgery. Pain is common symptom to improve.
Motor deficits improve better than sensory deficits and bladder dysfunctions post
operatively.Outcome of these patients are always at risk of retethering and delayed
neurological deterioration.
Conclusion: Therefore, close monitoring by a multidisciplinary team is important.
Inadequate treatment at peripheral centres should be avoided. Spinal dysraphism
patients should be referred to higher tertiary centre where the complete team is
available.