SA Orthopaedic Journal
On-line version ISSN 2309-8309
HOFFMAN, EB. The orthopaedic management of myelomeningocoele: GT du Toit founders lecture, SAOA Congress, September 2010. SA orthop. j. [online]. 2011, vol.10, n.3, pp. 48-55. ISSN 2309-8309.
Myelomeningocoele is the commonest congenital birth defect.1 The Cape Town prevalence has been reported as 2.5 per 1 000 births in the white population and 1 per 1 000 births in the black and coloured population.2 The incidence at Red Cross Children's Hospital has remained static at a mean of 12 new patients a year since 1987. Although this is a relative decrease, it remains significantly high. Part of the reason is that the foetal anomaly ultrasound (and elective termination) available to all antenatal patients in the Western Cape is not utilised by unbooked patients. The incidence of elective termination in the USA is 23%.3 Myelomeningocoele requires a multi-disciplinary approach. At Red Cross Children's Hospital the weekly spinal defects clinic involves neurosurgeons, urologists and stomatherapists (who teach the patients bladder and bowel care), orthopaedic surgeons and orthoptists. Neurosurgeons do the primary closure and insert and maintain a ventriculo-peritoneal shunt in 95% of the patients who have hydrocephalus due to an Arnold-Chiari malformation. Urologists treat the ninety per cent of patients who are incontinent. Orthopaedics has protean applications in myelomeningocoele.
Keywords : Myelomeningocoele; orthopaedic management.