# Myelomeningocele Orthopaedic Aspects

> Myelomeningocele orthopaedic aspects for NEET-PG Orthopaedics: neurological level and deformity, hip dislocation, clubfoot and prognosis for ambulation.

- Canonical URL: https://prepelephant.com/topics/neet-pg/orthopaedics/myelomeningocele-orthopaedic-aspects
- Exam / course: NEET-PG · Subject: Orthopaedics
- Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team
- First published: 2026-10-14
- Last updated: 2026-10-14
- Reference basis: Campbell's Operative Orthopaedics; Apley's System of Orthopaedics and Fractures
- How to cite: "Myelomeningocele Orthopaedic Aspects", PrepElephant, https://prepelephant.com/topics/neet-pg/orthopaedics/myelomeningocele-orthopaedic-aspects

## Direct answer

Myelomeningocele is an open neural tube defect whose orthopaedic deformities follow the level of the spinal lesion, because muscles below it are paralysed and the unopposed pull of the remaining muscles produces predictable deformities. The hip needs early assessment, since flexion, adduction and internal rotation contractures predispose it to dislocation, although the aim is a level pelvis and a contracture-free hip rather than reduction at all costs. Ambulation depends on the neurological level, with thoracic and high lumbar lesions usually needing a wheelchair.

## What you must remember

- **Neurological level:** the lowest level of intact function predicts the pattern of deformity and the potential for walking.
- **Hip dislocation:** flexion, adduction and internal rotation contractures predispose to dislocation, commonest with mid-lumbar lesions; contractures and pelvic obliquity are treated, but reduction of a dislocated hip does not reliably improve walking.
- **Foot deformity:** equinovarus or calcaneovalgus depends on the balance of paralysed and preserved muscles.
- **Spinal deformity:** scoliosis and kyphosis are common, with scoliosis often progressive in higher lesions.
- **Associated neurosurgical problems:** hydrocephalus, Chiari II malformation and neurogenic bladder form part of the wider picture.
- **Latex allergy:** a recognised hazard in these children, so latex-free equipment and anaesthesia are needed.
- **Prognosis:** ambulation is set by the level, while deformity management aims at a stable, plantigrade foot and a hip that stays located.

## Matching the neurological level to the likely deformity

A newborn with a lumbar myelomeningocele needs a plan for the hips and feet before the child can stand. The lesion level is used to predict the deformity and the walking potential.

| Neurological level | Typical deformity | Likely ambulation |
|---|---|---|
| Thoracic to upper lumbar | Hip flexion contracture, hip dislocation risk and spinal deformity | Usually a wheelchair, with some household walking using orthoses |
| Mid lumbar | Hip and knee contractures, hip dislocation and foot imbalance | Household or community walking with orthoses |
| Lower lumbar | Equinovarus or calcaneovalgus and hindfoot deformity | Community walking, often with ankle-foot orthoses |
| Sacral | Mild foot imbalance, with a calcaneus pattern in some | Often independent walking, sometimes with simple orthoses |

Each row describes the typical rather than the certain pattern, because individual muscle balance varies. Orthopaedic planning therefore starts with a muscle-by-muscle examination, not the level alone. Parents are counselled early that a supple, contracture-free hip and a plantigrade foot matter more than hip reduction or the walking question, because they shape sitting, transfers and the use of orthoses.

## Where the exam tries to catch you

Examiners test the level-deformity relationship and the associated hazards.

- **Trap:** operating to reduce every dislocated hip to improve walking. — **Correct:** reduction does not reliably improve function, so surgery aims at contractures, pelvic level and a plantigrade foot, and the hip is assessed early.
- **Trap:** assuming the spinal segment alone decides walking. — **Correct:** ambulation depends on the lowest level of functioning muscle, so it must be defined by examination rather than assumed.
- **Trap:** using latex equipment during surgery in a child with myelomeningocele. — **Correct:** these children carry a high risk of latex allergy, so latex-free equipment is used throughout care.

## Frequently asked questions

### Why does the hip need early assessment in myelomeningocele?

The hip needs early assessment in myelomeningocele, because flexion, adduction and internal rotation contractures predispose it to dislocation, especially with mid-lumbar lesions. Contractures and pelvic obliquity are treated, but reduction of a dislocated hip does not reliably improve walking.

### How does the neurological level predict ambulation in myelomeningocele?

The neurological level predicts ambulation because it reflects the lowest level of functioning muscle, which decides whether a child can walk. Thoracic and high lumbar lesions usually need a wheelchair, while lower lumbar lesions often allow community walking with orthoses.

### Why is latex precaution needed in myelomeningocele?

Children with myelomeningocele have a high risk of latex allergy, which can cause serious reactions during procedures. Latex-free gloves, catheters and equipment should therefore be used throughout surgery, anaesthesia and routine care.

### Which foot deformities are common in myelomeningocele?

Equinovarus and calcaneovalgus are the common foot deformities in myelomeningocele, and their pattern depends on which muscles are paralysed. Foot deformities in myelomeningocele need early assessment and orthoses, with surgery planned once the pattern is clear.