Central nervous system lesions and developmental scoliosis in myelomeningocele.

Hydrocephalus, spinal cord tethering, cord atresia, hydromyelia, syringomyelia and various manifestations of the Arnold-Chiari malformation occur in association with scoliosis in patients with myelomeningocele. While the causes of the cord lesions remain debatable, these lesions appear to be progressive and causally related to the scoliotic deformity. We have reviewed seventeen myelomeningocele patients with developmental scoliosis and have found that aggressive orthopaedic treatment combined with neurosurgical treatment can satisfactorily control spinal deformity in most cases. Before undertaking orthopaedic treatment of severe spinal deformities in patients with myelomeningocele a careful investigation of the central nervous system with myelography and cord and head CT scans should be carried out.