Spina bifida cystica. An orthopaedic criterion for the early closure of myelomeningocoeles.

There is an urgent need for criteria upon which to base the decision to close a myelomeningocoele soon after birth. Orthopaedic experience advises that early closure of the spinal lesion should not be done unless there is active flexion power at both hips. This criterion is offered with the knowledge that there may occasionally be other exceptional factors to contradict it, but it is based on experience of 96 personal cases aged between 18 months and 7 years. These cases are analysed and discussed. A further possible criterion for not closing the spinal lesion early is the presence of a gross lumbosacral kyphosis.