[P3-190] Spina dysraphism : neurological outcome in a Malaysian cohort
Introduction: Children with spinal dysraphism (SD) experience variable neurological impairments including reduced mobility, hydrocephalus and cognitive dysfunction. We describe the neurological outcome in a cohort of patients in a tertiary centre with a multidisciplinary SD clinic.
Methodology: A cross-sectional retrospective study was conducted in 2015 in a cohort of patient managed since 1997. Patients less than 12 months old were excluded. For each patient, epidemiological, clinical and radiological data were reviewed to correlate with neurological outcome.
Results: 57 patients were studied with mean age of 12.0 years and mean length of care 9.7 years. Lumbo-sacral or sacral lesions were found in 74% of patients. Ambulation was achieved in 70%, orthoses prescribed in 59% and and walking aids required in 37% of patients. Ambulation was significantly associated with low anatomical level, low motor level, low sensory level, closed dysraphism, absence of hydrocephalus at birth, absence of developmental hip dysplasia (DDH) and absence of spine deformity. On multiple logistic regression analysis, only absence of DDH was significant (p =0.032) with an odds ratio (OR) of 9.750 (95% CI of 1.2 -77.7). Normal school placement was achieved in 69%, significantly associated with absence of hydrocephalus, absence of a shunt and absent Chiari malformation. Only absence of hydrocephalus was significant on multiple logistic regression analysis with OR of 20.0 (95% CI 3.0 -131.7).
Conclusions: Neurological outcome in SD has improved with advances in medical and surgical therapy. In low level lesions, the absence of DDH is a predictor of mobility.
Methodology: A cross-sectional retrospective study was conducted in 2015 in a cohort of patient managed since 1997. Patients less than 12 months old were excluded. For each patient, epidemiological, clinical and radiological data were reviewed to correlate with neurological outcome.
Results: 57 patients were studied with mean age of 12.0 years and mean length of care 9.7 years. Lumbo-sacral or sacral lesions were found in 74% of patients. Ambulation was achieved in 70%, orthoses prescribed in 59% and and walking aids required in 37% of patients. Ambulation was significantly associated with low anatomical level, low motor level, low sensory level, closed dysraphism, absence of hydrocephalus at birth, absence of developmental hip dysplasia (DDH) and absence of spine deformity. On multiple logistic regression analysis, only absence of DDH was significant (p =0.032) with an odds ratio (OR) of 9.750 (95% CI of 1.2 -77.7). Normal school placement was achieved in 69%, significantly associated with absence of hydrocephalus, absence of a shunt and absent Chiari malformation. Only absence of hydrocephalus was significant on multiple logistic regression analysis with OR of 20.0 (95% CI 3.0 -131.7).
Conclusions: Neurological outcome in SD has improved with advances in medical and surgical therapy. In low level lesions, the absence of DDH is a predictor of mobility.