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.