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. 1972 Dec;47(256):854–873. doi: 10.1136/adc.47.256.854

Spina Bifida Cystica

Results of Treatment of 270 Consecutive Cases with Criteria for Selection for the Future

John Lorber
PMCID: PMC1648403  PMID: 4567074

Abstract

The disappointing results of treatment in 270 consecutive unselected cases of spina bifida admitted during a 27-month period are detailed. Massive effort has led to much avoidable suffering at an exorbitant cost in manpower and money. This study confirms the validity of those adverse prognostic criteria defined in an earlier study and which form a basis for selection. These are (1) thoracolumbar lesions, (2) severe paraplegia, (3) gross enlargement of head, (4) kyphosis, and (5) other severe congenital defects, or birth injuries. It is shown again that selection is possible on the first day of life on purely objective criteria; that it is essential for the benefit of all those affected—whether they are for treatment or no treatment; and that it is in the interest of their families and the community.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Brocklehurst G., Gleave J. R., Lewin W. Early closure of myelomeningocele, with special reference to leg movement. Br Med J. 1967 Mar 18;1(5541):666–669. doi: 10.1136/bmj.1.5541.666. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Cook R. C., Lister J., Zachary R. B. Operative management of the neurogenic bladder in children: diversion through intestinal conduits. Surgery. 1968 May;63(5):825–831. [PubMed] [Google Scholar]
  3. DORAN P. A., GUTHKELCH A. N. Studies in spina bifida cystica. I. General survey and reassessment of the problem. J Neurol Neurosurg Psychiatry. 1961 Nov;24:331–345. doi: 10.1136/jnnp.24.4.331. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Duckworth T., Brown B. H. Changes in muscle activity following early closure in myelomeningocele. Dev Med Child Neurol Suppl. 1970;22(Suppl):39+–39+. doi: 10.1111/j.1469-8749.1970.tb03001.x. [DOI] [PubMed] [Google Scholar]
  5. FORRESTER R. M. SALVAGE. Lancet. 1965 Jan 30;1(7379):262–263. doi: 10.1016/s0140-6736(65)91542-4. [DOI] [PubMed] [Google Scholar]
  6. Finlay H. V. Selecting cases of myelomeningocele for surgery. Br Med J. 1971 Aug 14;3(5771):429–429. doi: 10.1136/bmj.3.5771.429. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Forrester R. M. Ethical and social aspects of treatment of spina bifida. Lancet. 1968 Nov 9;2(7576):1033–1033. doi: 10.1016/s0140-6736(68)91325-1. [DOI] [PubMed] [Google Scholar]
  8. Freeman J. M. Is there a right to die--quickly? J Pediatr. 1972 May;80(5):904–905. doi: 10.1016/s0022-3476(72)80166-5. [DOI] [PubMed] [Google Scholar]
  9. Freeston B. M. An enquiry into the effect of a spina bifida child upon family life. Dev Med Child Neurol. 1971 Aug;13(4):456–461. doi: 10.1111/j.1469-8749.1971.tb03052.x. [DOI] [PubMed] [Google Scholar]
  10. Hare E. H., Laurence K. M., Payne H., Rawnsley K. Spina bifida cystica and family stress. Br Med J. 1966 Sep 24;2(5516):757–760. doi: 10.1136/bmj.2.5516.757. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Hide D. W., Williams H. P., Ellis H. L. The outlook for the child with a myelomeningocele for whom early surgery was considered inadvisable. Dev Med Child Neurol. 1972 Jun;14(3):304–307. doi: 10.1111/j.1469-8749.1972.tb02594.x. [DOI] [PubMed] [Google Scholar]
  12. James C. C. Spina bifida cystica. An orthopaedic criterion for the early closure of myelomeningocoeles. J Neurol Neurosurg Psychiatry. 1971 Dec;34(6):723–725. doi: 10.1136/jnnp.34.6.723. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Katzen M. The decision to treat myelomeningocele on the first day of life. S Afr Med J. 1971 Mar 27;45(13):345–349. [PubMed] [Google Scholar]
  14. LORBER J., SEGALL M. Bacterial meningitis in spina bifida cystica. A review of 37 cases. Arch Dis Child. 1962 Jun;37:300–308. doi: 10.1136/adc.37.193.300. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. LORBER J. Systematic ventriculographic studies in infants born with meningomyelocele and encephalocele. The incidence and development of hydrocephalus. Arch Dis Child. 1961 Aug;36:381–389. doi: 10.1136/adc.36.188.381. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. LORBER J. The diagnosis and management of hydrocephalus in infancy. N Z Med J. 1961 Sep;60:416–418. [PubMed] [Google Scholar]
  17. Lightowler C. D. Meningomyelocele: the price of treatment. Br Med J. 1971 May 15;2(5758):385–387. doi: 10.1136/bmj.2.5758.385. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Lister J., Cook R. C., Zachary R. B. Operative management of neurogenic bladder dysfunction in children: ureterostomy. Arch Dis Child. 1968 Dec;43(232):672–678. doi: 10.1136/adc.43.232.672. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Lorber J., Kalhan S. C., Mahgrefte B. Treatment of ventriculitis with gentamicin and cloxacillin in infants born with spina bifida. Arch Dis Child. 1970 Apr;45(240):178–185. doi: 10.1136/adc.45.240.178. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Lorber J. Medical and surgical aspects in the treatment of congenital hydrocephalus. Neuropadiatrie. 1971 Feb;2(3):239–246. doi: 10.1055/s-0028-1091785. [DOI] [PubMed] [Google Scholar]
  21. Lorber J. Nalidixic acid in chronic urinary-tract infections in children. Practitioner. 1967 May;198(187):684–687. [PubMed] [Google Scholar]
  22. Lorber J. Recovery of vision following prolonged blindness in children with hydrocephalus or following pyogenic meningitis. Clin Pediatr (Phila) 1967 Dec;6(12):699–703. doi: 10.1177/000992286700601212. [DOI] [PubMed] [Google Scholar]
  23. Lorber J. Results of treatment of myelomeningocele. An analysis of 524 unselected cases, with special reference to possible selection for treatment. Dev Med Child Neurol. 1971 Jun;13(3):279–303. [PubMed] [Google Scholar]
  24. Lorger J., Lyons V. H. Arterial hypertension in children with spina bifida cystica and urinary incontinence. Dev Med Child Neurol Suppl. 1970;22(Suppl):101+–101+. [PubMed] [Google Scholar]
  25. Matson D. D. Surgical treatment of myelomeningocele. Pediatrics. 1968 Aug;42(2):225–227. [PubMed] [Google Scholar]
  26. Mellins R. B., Balfour H. H., Jr, Turino G. M., Winters R. W. Failure of automatic control of ventilation (Ondine's curse). Report of an infant born with this syndrome and review of the literature. Medicine (Baltimore) 1970 Nov;49(6):487–504. [PubMed] [Google Scholar]
  27. O'NEILL E. M. Normal head growth and the prediction of head size in infantile hydrocephalus. Arch Dis Child. 1961 Jun;36:241–252. doi: 10.1136/adc.36.187.241. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Pekarovic E., Robinson A., Zachary R. B. Intravesical pressure measurements: simultaneous filling and recording through one suprapubic cannula. Br J Urol. 1969 Aug;41(4):475–480. doi: 10.1111/j.1464-410x.1969.tb09950.x. [DOI] [PubMed] [Google Scholar]
  29. SHARRARD W. J. POSTERIOR ILIOPSOAS TRANSPLANTATION IN THE TREATMENT OF PARALYTIC DISLOCATION OF THE HIP. J Bone Joint Surg Br. 1964 Aug;46:426–444. [PubMed] [Google Scholar]
  30. Sharrard W. J., Grosfield I. The management of deformity and paralysis of the foot in myelomeningocele. J Bone Joint Surg Br. 1968 Aug;50(3):456–465. [PubMed] [Google Scholar]
  31. Sharrard W. J. Spinal osteotomy for congenital kyphosis in myelomeningocele. J Bone Joint Surg Br. 1968 Aug;50(3):466–471. [PubMed] [Google Scholar]
  32. Slater E. Health service or sickness service? Br Med J. 1971 Dec 18;4(5789):734–736. doi: 10.1136/bmj.4.5789.734. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Smith E. D. Follow-up studies on 150 ileal conduits in children. J Pediatr Surg. 1972 Feb;7(1):1–10. doi: 10.1016/0022-3468(72)90393-4. [DOI] [PubMed] [Google Scholar]
  34. Stark G. D. Neonatal assessment of the child with a myelomeningocele. Arch Dis Child. 1971 Aug;46(248):539–548. doi: 10.1136/adc.46.248.539. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Walker J. H., Thomas M., Russell I. T. Spina bifida--and the parents. Dev Med Child Neurol. 1971 Aug;13(4):462–476. doi: 10.1111/j.1469-8749.1971.tb03053.x. [DOI] [PubMed] [Google Scholar]
  36. Wickes I. G. Ethical and social aspects of treatment of spina bifida. Lancet. 1968 Sep 21;2(7569):677–677. doi: 10.1016/s0140-6736(68)92523-3. [DOI] [PubMed] [Google Scholar]
  37. Zachary R. B. Ethical and social aspects of treatment of spina bifida. Lancet. 1968 Aug 3;2(7562):274–276. doi: 10.1016/s0140-6736(68)92369-6. [DOI] [PubMed] [Google Scholar]

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