Myelomeningocele at the Sacral Level

Neurological lesions at the sacral level account for approximately one-fifth of all myelomeningoceles reported in the literature. It is commonly accepted that patients who have such a lesion function at or near normal levels and have few complications, unlike patients who have a lesion of the lumbar or thoracic spine. Health-care professionals at centers that manage a large number of children who have a myelomeningocele tend to focus their attention and energies an the patients who have a high -level lesion because reports have suggested that 95 per cent of patients who have a sacral lesion remain community ambulators. Children who have a lesion at the sacral level are believed to integrate mare easily inlo regular schools, since they often do not use braces or walking aids and the myelomeningocele commonly goes unnoticed by their peers. Long-term studies of this group of patients have been difficult because patients arc generally discharged from a center and are lost to follow-up when they reach maturity. and few centers specialize in the care of adults who have a myelomeningocele.

At Rancho Los Amigos Medical Center, all patients who have a myelomeningocele are seen at least once a year from birth throughout their lives. This fact made it possible to investigate the long·term outcomes of patients who had a myelomeningocele at the sacral level.

Materials and Methods

We reviewed the medical records of all adults who had a myelomeningocele and who had been followed at the Rancho Los Amigos Medical Center, Downey, California, since 1958, Thirty-six of forty-eight patients who had a neurological lesion at the sacral level were available for f()llow-up. The twelve patients who were lost to follow-up had moved out of the Los Angeles area during childhood or adolescence. Of the thirty-six patients...