Spina Bifida

Goals

  1. Make the diagnosis.
  2. Establish the level of the lesion – strongly correlates with function.

Examination

Look (Standing if Possible)

  • Orthoses:
    • Observe for the presence and type of orthoses, which can indicate functional level.
  • Catheter:
    • Presence of a catheter suggests a lower functional level.
  • Muscle Wasting:
    • Assess for wasting in the lower limbs.
  • Deformities:
    • Identify any visible limb deformities.
  • Leg Length Discrepancy:
    • Measure for differences in leg length.
  • Limb Hypoplasia:
    • Look for underdeveloped limbs.
  • Hip Dislocation:
    • Check for signs of hip dislocation.
  • Spine:
    • Scoliosis:
      • Present in:
        • 90% of cases with thoracic-level lesions.
        • 20% of cases with L5 or below lesions.
    • Myelomeningocele:
      • Observe for evidence of repaired or open myelomeningocele.
    • Stigmata of Dysraphism:
      • Pits, hairy patches, café-au-lait spots, or other cutaneous markers.
  • Feet:
    • Look for ulcers or pressure sores.
    • Identify foot deformities.

Feel

  • Sensory Examination:
    • Quantify the level of sensory loss using dermatomal mapping.

Move

  • Tone:
    • Assess for spasticity or hypotonia.
  • Motor Power:
    • Test muscle strength in all key groups.
  • Reflexes:
    • Check deep tendon reflexes (DTRs).
  • Range of Motion (ROM):
    • Assess ROM in the hips, knees, and ankles.
    • Look for:
      • Dislocations.
      • Joint contractures.
      • Spasticity.
      • Arthrosis.

Gait

  • Observe gait:
    • With and without orthotics.
    • Note any compensatory mechanisms or abnormal patterns.

Finishing

  1. Take a full history, focusing on developmental milestones and functional abilities.
  2. Correlate clinical findings with imaging (MRI/CT or spinal X-rays) to confirm the level of the lesion.
  3. Perform additional evaluations as needed, such as urodynamic studies or orthopedic imaging.

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