Strategie terapeutiche nel trattamento ortopedico della spina bifida

Aims and background. The authors comment on the treatment of patients suffering from spina bifida. Methods. The analysis of a series of 71 patients with spina bifida treated over the course of 20 years has enabled the authors to evaluate the main sites of deformity, examine the treatment carried out in relation to the levels of damage and observe the resulting functional autonomy. Results. The foot was the site which offered the most frequent opportunities for treatment at all levels. Knee deformities were treated in a few cases. In particular, difficulties arose when treating the L3-L4-L5 neurosegmental levels of the hip, with the result that bone correction is currently associated with muscle transposition (external m. obliquo) in order to ensure dynamic correction. Conclusions. The authors emphasise the need for a more cautious surgical approach given that the alignment of the lower limbs, often achieved using orthopedic aids and splints, is more important from a functional point of view than the anatomic and radiographical correction of deformities. From a functional point of view, it was seen that apparently positive neurosegmental levels are penalised by the lack of early training using splints, whereas, on the contrary, even severe clinical conditions can acquire increased functional autonomy if splints are introduced early to aid walking. On the contrary, there were increased indications for spine surgery in patients suffering from severe paraplegia in order to improve cardiorespiratory function.