Neurological classification in myelomeningocele as a spine deformity predictor.

In myelomeningocele, spinal deformities are responsible for major disability. Our aim was to check the predictive power for future spine deformity of a neurological classification applied at 5 years of age. We classified patients into four groups according to their neurological examination made at the age of 5 years. Groups were defined as follows: group I, L5 or below (meaning that all the patients in this group have a paralysis that at least leaves the L5 segment intact); group II, L3-L4; group III, L1-L2; group IV, T12 and above (meaning that all the patients in this group have a paralysis that reaches T11 or above). One hundred and sixty-three patients were included. The results showed that group I is a predictor for the absence of spinal deformity. Group III or IV is a predictor for spinal deformity. Group IV is a predictor of kyphosis. It was previously known that the higher the neurological level, the higher the rate of spinal deformity at maturity, but no work had given physicians a guideline to assess the spinal prognosis in myelomeningocele patients. Our work showed, on the basis of this classification made at the age of 5 years, that future spinal disorders may be expected in some patients, while no spinal deformity may be expected in some others. Thus, an appropriate therapeutic strategy and follow-up can be planned.