Walking ability in mature patients with spina bifida.

The ambulatory status of 50 patients, aged 15 years and older, with spina bifida is assessed and related to the level of the lesion, the stability and presence of deformity at the hip joints, and the presence of pelvic obliquity and of scoliosis. A retrospective study was made of these variables for the year the child began walking and, when applicable, the year the child stopped walking. More than two-thirds of the group were community ambulators. Lesion review, and there were no household or nonfunctional ambulators. Lesion levels of the ambulators ranged from T11 to S2-S3, whereas lesion levels of the nonambulators ranged from T12 to L3-L4/L4. Most of the hips were not dislocated because the patients had undergone early surgery to restore muscle balance at the hip and, thus, to prevent dislocation. Some had undergone surgery to reduce hip dislocation, although it appears that such surgery is unnecessary for those with high lesions who use long calipers and whose hips require only flexion and extension ability in ambulation. Surgery resulted in significant limitation of flexion range at the hip in one instance only. Those ambulators with high lesions were compared with nonambulators, almost all of whom also had high lesions. The combination of hip flexion deformity, pelvic obliquity, and scoliosis is likely to preclude walking as is the presence of any one of these factors to a severe degree.