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The Role of Scoliosis and Pelvic Obliquity on Functional Disability in Myelomeningocele

A retrospective analysis of 39 patients with myelomeningocele over age 16 was done to determine the effects of scoliosis and pelvic obliquity on their ambulatory ability and function. Although primarily dependent on neurologic level, prevention of an unbalanced spine and maintenance of ambulatory status also appeared to correlate closely with a curvature less than 40º and a pelvic obliquity less than 25º. All ambulators, regardless of neurologic level, had a pelvic obliquity of 25º or less. Of the 19 ambulators, all but two had curvatures of 40º or less. Ten of the 11 unbalanced sitters had a curvature of 35º or more and a pelvic obliquity greater than 25º. The quality of life style also appeared to correlate well with the severity of scoliosis and pelvic obliquity. Sixteen untreated patients with progressive curvatures prior to age 16 appeared to have insignificant curve progression past age 16. Twelve patients underwent posterior fusion in situ. This procedure alone is not recommended for the treatment of scoliosis associated with myelomeningocele because of the high morbidity.