Myelodysplasia; Spina Bifida

• Failure of closure of fetal spinal cord, presenting with anatomic and neurologic impairments

• Folate deficiency - supplementation decreases risk by 70%
• Valproic acid
• Maternal diabetes
• Maternal hyperthermia

• Spina Bifida Occulta
• Can present with hemangioma, portwine stain, pseudotail with lipomna, hypertrichosis

• Meningocele = protruding sac without spinal elements
• Myelomeningocele = protruding sac with spinal elements
• Rachishsis = cleft throughout the spine

• Can be confusing! if Lesion at L3, then L2 and above is still functioning.

L2 - non ambulator L3 - marginal home ambulation. Hip dislocation ++. Equinovarus foot. L4 - Household ambulation. Equinovarus foot. L5 - Community. Calcaneovalgus foot. S - Community. Pes Cavus Foot

• Occurs when knee is flexed (looses extension at L3) and Hips are flexed (L2 maintained)
• Highest risk is thus defect at L3.

• Latex allergy (reported 20-70%)
• Cause is unknown, may be due to early, constant exposure to rubber products among thse children

• Sacral myelodysplasia means L5 and above intact
• Elevated longitudinal arch aka cavus is the primary deformity
• Varus then results from muscle imbalance between posterior tibialis and peroneal muscles

• L5 lesion means L4 and above intact and dorsiflexion is intact
• It is most common in patients with L4 or L5 level of involvement, “due to the strength or spasticity of the ankle dorsiflexors combined with weak or absent plantar flexors”
• Calcaneus or Calcaneovalgus.

• Most common in patients with L5 and L4 levels of involvement due to strength or spasticity of ankle dorsiflexors combined with weak or absent plantar flexors

• Anterior tibialis tendon transfer to calcaneus with anterolateral ankle release

• If lesion is at L4, means L3 and above intact. Means dorsiflexion is also affected.
• Equinovarus foot aka Club foot
• Occurs in 90% of patients with thoracic or lumbar levels
• Develop due to “retained activity of tibialis muscles” in combination with the “functional absence of peroneal muscles”

• L3 = L4 and below weak = equinovarus foot + foot drop
• L2 = L3 and below weak = + Knee extensors weak
• L1 = L2 and below weak = + Hip flexors weak

• Ponseti method - can be successful in most cases.
• +/- soft tissue release later