Spasticity in Spina Bifida

  • David Douglas Cochrane
  • Richard Beauchamp
  • Carol King
  • Andrew MacNeily


Progressive deterioration in function due to neurological, musculoskeletal and urological complications in patients with spina bifida is not uncommon.


Botulinum Toxin Spina Bifida Pelvic Obliquity Spastic Cerebral Palsy Neurogenic Bladder Dysfunction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Alexander E, Garvey FK, Boyce W (1954) Congenital lumbosacral myelomeningocele with incontinence. J Neurosurg 11:183–191PubMedGoogle Scholar
  2. 2.
    Asher M, Olson J (1983) Factors affecting the ambulatory status of patients with spina bifida cystica. J Bone Joint Surg Am 65:350–356PubMedGoogle Scholar
  3. 3.
    Cochrane DD, Rassekh SR, Thiessen PN (1998) Functional deterioration following placode untethering in myelomeningocele. Pediatr Neurosurg 28:57–62PubMedCrossRefGoogle Scholar
  4. 4.
    Koyanagi I, Iwasaki Y, Hida K et al (1997) Surgical treatment of syringomyelia associated with spinal dysraphism. Childs Nerv Syst 13:194–200PubMedCrossRefGoogle Scholar
  5. 5.
    LaMarca F, Herman M, Grant JA et al (1997) Presentation and management of hydromyelia in children with Chiari type-II malformation. Pediatr Neurosurg 26:57–67PubMedCrossRefGoogle Scholar
  6. 6.
    Rauzzino M, Oakes WJ (1995) Chiari II malformation and syringomyelia. Neurosurg Clin N Am 6:293–309PubMedGoogle Scholar
  7. 7.
    Reigel DH, Tchernoukha K, Bazmi B et al (1994) Change in spinal curvature following release of tethered spinal cord associated with spina bifida. Pediatr Neurosurg 20:30–42PubMedCrossRefGoogle Scholar
  8. 8.
    Sarwark JF, Weber DT, Gabrieli AP et al (1996) Tethered cord syndrome in low motor level children with myelomeningocele. Pediatr Neurosurg 25:295–301PubMedCrossRefGoogle Scholar
  9. 9.
    Storrs BB (1987) Selective posterior rhizotomy for treatment of progressive spasticity in patients with myelomeningocele. Preliminary report. Pediatr Neurosci 13:135–137PubMedCrossRefGoogle Scholar
  10. 10.
    Tamaki N, Shirataki K, Kojima N et al (1988) Tethered cord syndrome of delayed onset following repair of myelomeningocele. J Neurosurg 69:393–398PubMedCrossRefGoogle Scholar
  11. 11.
    Venes JL, Stevens EA (1983) Surgical pathology in tethered cord secondary to myelomeningocele repair. Concepts Pediat Neurosurg 4:165–185Google Scholar
  12. 12.
    Chambers GK, Cochrane DD, Irwin B et al (1996) Assessment of the appropriateness of services provided by a multidisciplinary meningomyelocele clinic. Pediatr Neurosurg 24:92–97PubMedCrossRefGoogle Scholar
  13. 13.
    Lance JW (1990) What is spasticity? Lancet 335:606PubMedCrossRefGoogle Scholar
  14. 14.
    Lance JW, Burke D (1974) Mechanisms of spasticity. Arch Phys Med Rehabil 55:332–337PubMedGoogle Scholar
  15. 15.
    Lance JW (1980) Symposium Synopsis In: Feldman RG, Young RR, Koella WP (eds) Spasticity: disordered motor control. Yearbook Medical, Chicago, pp 485–494Google Scholar
  16. 16.
    Sanger TD, Delgado MR, Gaebler-Spira D et al (2003) Task Force on Childhood Motor D: Classification and definition of disorders causing hypertonia in childhood. Pediatrics 111:e89–97CrossRefGoogle Scholar
  17. 17.
    Sharrard WJW (1963) Spina bifida. Paraplegia 1:190–199Google Scholar
  18. 18.
    Sharrard WJW (1964) The segmental innervation of the lower limb muscles in man. Ann R Coll Surg Engl 35:106–122PubMedGoogle Scholar
  19. 19.
    Stark GD, Drummond M (1971) The spinal cord lesion in myelomeningocele. Dev Med Child Neurol 13 suppl 25:1–15Google Scholar
  20. 20.
    Geerdink N, Pasman JW, Roeleveld N et al (2006) Responses to lumbar magnetic stimulation in newborns with spina bifida. Pediatr Neurol 34:101–105PubMedCrossRefGoogle Scholar
  21. 21.
    Menelaus MB (1980) The orthopaedic management of spina bifida cystica. Churchill Livingstone, EdinburghGoogle Scholar
  22. 22.
    Sival DA, Brouwer OF, Bruggink JL et al (2006) Movement analysis in neonates with spina bifida aperta. Early Hum Dev 82:227–234PubMedCrossRefGoogle Scholar
  23. 23.
    Sival DA, Brouwer OF, Sauer PJ et al (2003) Transiently present leg movements in neonates with spina bifida aperta are generated by motor neurons located cranially from the spinal defect. Eur J Pediatr Surg 13 Suppl 1:S31–32PubMedCrossRefGoogle Scholar
  24. 24.
    Sival DA, van Weerden TW, Vles JS et al (2004) Neonatal loss of motor function in human spina bifida aperta. Pediatrics 114:427–434PubMedCrossRefGoogle Scholar
  25. 25.
    Caldarelli M, Di Rocco C, Colosimo C et al (1995) Surgical treatment of late neurological deterioration in children with myelodysplasia. Acta Neurochir (Wien) 137:199–206CrossRefGoogle Scholar
  26. 26.
    McLone DG, Herman JM, Gabrieli AP et al (1990) Tethered cord as a cause of scoliosis in children with a myelomeningocele. Pediatr Neurosurg 16:8–13PubMedCrossRefGoogle Scholar
  27. 27.
    McLone DG, LaMarca F (1997) The tethered spinal cord: diagnosis, significance, and management. Semin Pediatr Neurol 4:192–208PubMedCrossRefGoogle Scholar
  28. 28.
    Ozaras N, Yalcin S, Ofluoglu D et al (2005) Are some cases of spina bifida combined with cerebral palsy? A study of 28 cases. Eura Medicophys 41:239–242PubMedGoogle Scholar
  29. 29.
    Sival DA, Brouwer OF, Meiners LC et al (2003) The influence of cerebral malformations on the quality of general movements in spina bifida aperta. Eur J Pediatr Surg 13Suppl 1:S29–30PubMedGoogle Scholar
  30. 30.
    Mazur JM, Menelaus MB (1991) Neurologic status of spina bifida patients and the orthopedic surgeon. Clin Orthop Relat Res 264:54–64PubMedGoogle Scholar
  31. 31.
    Bartonek A, Gutierrez EM, Haglund-Akerlind Y et al (2005) The influence of spasticity in the lower limb muscles on gait pattern in children with sacral to midlumbar myelomeningocele: a gait analysis study. Gait Posture 22:10–25PubMedCrossRefGoogle Scholar
  32. 32.
    Bartonek A, Saraste H (2001) Factors influencing ambulation in myelomeningocele: a cross-sectional study. Dev Med Child Neurol 43:253–260PubMedCrossRefGoogle Scholar
  33. 33.
    Fraser RK, Hoffman EB, Sparks LT et al (1992) The unstable hip and mid-lumbar myelomeningocele. J Bone Joint Surg Br 74:143–146PubMedGoogle Scholar
  34. 34.
    Frawley PA, Broughton NS, Menelaus MB (1998) Incidence and type of hindfoot deformities in patients with low-level spina bifida. J Pediatr Orthop 18:312–313PubMedCrossRefGoogle Scholar
  35. 35.
    Mazur JM, Stillwell A, Menelaus M (1986) The significance of spasticity in the upper and lower limbs in myelomeningocele. J Bone Joint Surg Br 68:213–217PubMedGoogle Scholar
  36. 36.
    Wright JG, Menelaus MB, Broughton NS et al (1991) Natural history of knee contractures in myelomeningocele. J Pediatr Orthop 11:725–730PubMedGoogle Scholar
  37. 37.
    Trivedi J, Thomson JD, Slakey JB et al (2002) Clinical and radiographic predictors of scoliosis in patients with myelomeningocele. J Bone Joint Surg Am 84-A:1389–1394PubMedGoogle Scholar
  38. 38.
    Isu T, Chono Y, Iwasaki Y et al (1992) Scoliosis associated with syringomyelia presenting in children. Childs Nerv Syst 8:97–100PubMedCrossRefGoogle Scholar
  39. 39.
    Cochrane DD, Finley C, Kestle J et al (2000) The patterns of late deterioration in patients with transitional lipomyelomeningocele. Eur J Pediatr Surg 10Suppl 1:13–17PubMedGoogle Scholar
  40. 40.
    James C, Lassman L (1981) Spina bifida occulta. Orthopedic, radiological and neurosurgical aspects. Academic Press, LondonGoogle Scholar
  41. 41.
    Carroll N (1987) Assessment and management of the lower extremity in myelodysplasia. Orthop Clin North Am 18:709–724PubMedGoogle Scholar
  42. 42.
    van Gool JD, Dik P, de Jong TP (2001) Bladder-sphincter dysfunction in myelomeningocele. Eur J Pediatr 160:414–420PubMedCrossRefGoogle Scholar
  43. 43.
    McDonnell GV, McCann JP (2000) Why do adults with spina bifida and hydrocephalus die? A clinic-based study. Eur J Pediatr Surg 10Suppl 1:31–32PubMedGoogle Scholar
  44. 44.
    Kendall FP, Rodgers MM, McCreary EK et al (2005) Muscle testing and function with posture and pain. Lippincott Williams and Wilkins, BaltimoreGoogle Scholar
  45. 45.
    Boyd NR, Ada L, Barnes MP et al (2001) Physiotherapy management of spasticity. In: Upper motor neurone syndrome and spasticity. Clinical management and neurophysiology. Cambridge University Press, Cambridge, pp 96–121Google Scholar
  46. 46.
    Boyd RN, Barwood SA, Ballieu C et al (1998) Validity of a clinical measure of spasticity in children with cerebral palsy in a randomized clinical trial. Dev Med Chid Neurol 40:7Google Scholar
  47. 47.
    Boyd RN, Graham HK (1999) Objective measurement of clinical findings in the use of botulinium toxin A in the management of children with cerebral palsy. Eur J Neurol 69Suppl 4:S23–S35CrossRefGoogle Scholar
  48. 48.
    Haugh AB, Pandyan AD, Johnson GR (2006) A systematic review of the Tardieu Scale for the measurement of spasticity. Disabil Rehabil 28:899–907PubMedCrossRefGoogle Scholar
  49. 49.
    Johnson GR, Barnes MP, Johnson GR (2001) Measurement of spasticity. In: Upper motor neurone syndrome and spasticity. Clinical management and neurophysiology. Cambridge University Press, Cambridge, pp 79–95Google Scholar
  50. 50.
    Scholtes VA, Becher JG, Beelen A et al (2006) Clinical assessment of spasticity in children with cerebral palsy: a critical review of available instruments. Dev Med Child Neurol 48:64–73PubMedCrossRefGoogle Scholar
  51. 51.
    Patrick E, Ada L (2006) The Tardieu Scale differentiates contracture from spasticity whereas the Ashworth Scale is confounded by it. Clin Rehabil 20:173–182PubMedCrossRefGoogle Scholar
  52. 52.
    Hoffer MM, Feiwell E, Perry R et al (1973) Functional ambulation in patients with myelomeningocele. J Bone Joint Surg Am 55:137–148PubMedGoogle Scholar
  53. 53.
    Williams EN, Carroll SG, Reddihough DS et al (2005) Investigation of the timed ‘up & go’ test in children. Dev Med Child Neurol 47:518–524PubMedCrossRefGoogle Scholar
  54. 54.
    Graham HK, Harvey A, Rodda J et al (2004) The Functional Mobility Scale (FMS). JPO 24:514–520Google Scholar
  55. 55.
    Kaefer M, Pabby A, Kelly M et al (1999) Improved bladder function after prophylactic treatment of the high risk neurogenic bladder in newborns with myelomentingocele. J Urol 162:1068–1071PubMedCrossRefGoogle Scholar
  56. 56.
    Wu HY, Baskin LS, Kogan BA (1997) Neurogenic bladder dysfunction due to myelomeningocele: neonatal versus childhood treatment. J Urol 157:2295–2297PubMedCrossRefGoogle Scholar
  57. 57.
    Tarcan T, Bauer S, Olmedo E et al (2001) Long-term follow up of newborns with myelodysplasia and normal urodynamic findings: Is follow up necessary? J Urol 165:564–567PubMedCrossRefGoogle Scholar
  58. 58.
    Kaplan WE, McLone DG, Richards I (1988) The urological manifestations of the tethered spinal cord. J Urol 140:1285–1288PubMedGoogle Scholar
  59. 59.
    Hall PV, Campbell RL, Kalsbeck JE (1975) Meningomyelocele and progressive hydromyelia. Progressive paresis in myelodysplasia. J Neurosurg 43:457–463PubMedGoogle Scholar
  60. 60.
    Gage J, Gormley M, Krach L et al (2004) Managing spasticity in children with cerebral palsy requires a team approach. In: A pediatric perspective, Gillette Children’s Specialty Healthcare, pp 1–6Google Scholar
  61. 61.
    DeJong S (2006) Contracture management of children with neuromuscular disabilities. In: APTA CSM Meeting, San DiegoGoogle Scholar
  62. 62.
    Pin T, Duyke P, Chan M (2006) The effectiveness of passive stretching in children with cerebral palsy. Dev Med Child Neurol 48:855–862PubMedCrossRefGoogle Scholar
  63. 63.
    Kirwood CA, Bardsley GI, Barnes MP et al (2001) Seating and positioning in spasticity. In: Upper motor neurone syndrome and spasticity. Clinical management and neurophysiology. Cambridge University Press, Cambridge, pp 122–139Google Scholar
  64. 64.
    Sharp SA, Brouwer BJ (1997) Isokinetic strength training of the hemiparetic knee: effects on function and spasticity. Arch Phys Med Rehabil 78:1231–1236PubMedCrossRefGoogle Scholar
  65. 65.
    Aslan AR, Kogan BA (2002) Conservative management in neurogenic bladder dysfunction. Curr Opin Urol 12:473–477PubMedCrossRefGoogle Scholar
  66. 66.
    Goessl C, Knispel HH, Fiedler U et al (1998) Urodynamic effects of oral oxybutynin chloride in children with myelomeningocele and detrusor hyperreflexia. Urology 51:94–98PubMedCrossRefGoogle Scholar
  67. 67.
    Goessl C, Sauter T, Michael T et al (2000) Efficacy and tolerability of tolterodine in children with detrusor hyperreflexia. Urology 55:414–418PubMedCrossRefGoogle Scholar
  68. 68.
    Nilvebrant L, Andersson KE, Gillberg PG et al (1997) Tolterodine—a new bladder-selective antimuscarinic agent. Eur J Pharmacol 327:195–207PubMedCrossRefGoogle Scholar
  69. 69.
    Madersbacher H (2002) Neurogenic bladder dysfunction in patients with myelomeningocele. Curr Opin Urol 12:469–472PubMedCrossRefGoogle Scholar
  70. 70.
    Seki N, Ikawa S, Takano N et al (2001) Intravesical instillation of resiniferatoxin for neurogenic bladder dysfunction in a patient with myelodysplasia. J Urol 166:2368–2369PubMedCrossRefGoogle Scholar
  71. 71.
    Jankovic J, Brin MF (1997) Botulinum toxin: historical perspective and potential new indications. Muscle Nerve Suppl 6:S129–145Google Scholar
  72. 72.
    Pierson SH, Katz DI, Tarsy D et al (1996) Botulinum toxin A in the treatment of spasticity: functional implications and patient selection. Arch Phys Med Rehabil 77:717–721PubMedCrossRefGoogle Scholar
  73. 73.
    Skeil D, Barnes M (1994) The local treatment of spasticity. Clin Rehabil 8:240–246CrossRefGoogle Scholar
  74. 74.
    Altaweel W, Jednack R, Bilodeau C et al (2006) Repeated intradetrusor botulinum toxin type A in children with neurogenic bladder due to myelomeningocele. J Urol 175:1102–1105PubMedCrossRefGoogle Scholar
  75. 75.
    Kajbafzadeh AM, Moosavi S, Tajik P et al (2006) Intravesical injection of botulinum toxin type A: management of neuropathic bladder and bowel dysfunction in children with myelomeningocele. Urology 68:1091–1096PubMedCrossRefGoogle Scholar
  76. 76.
    Patel AK, Patterson JM, Chapple CR (2006) Botulinum toxin injections for neurogenic and idiopathic detrusor overactivity: A critical analysis of results. Eur Urol 50:684–709; discussion 709-610PubMedCrossRefGoogle Scholar
  77. 77.
    Schulte-Baukloh H, Michael T, Sturzebecher B et al (2003) Botulinum-a toxin detrusor injection as a novel approach in the treatment of bladder spasticity in children with neurogenic bladder. Eur Urol 44:139–143PubMedCrossRefGoogle Scholar
  78. 78.
    Karmel-Ross K, Cooperman DR, Van Doren CL (1992) The effect of electrical stimulation on quadriceps femoris muscle torque in children with spina bifida. Phys Ther 72:723–730PubMedGoogle Scholar
  79. 79.
    Madersbacher H, Fischer J (1993) Sacral anterior root stimulation: prerequisites and indications. Neurourol Urodyn 12:489–494PubMedCrossRefGoogle Scholar
  80. 80.
    Schmale GA, Eilert RE, Chang F et al (2006) High reoperation rates after early treatment of the subluxating hip in children with spastic cerebral palsy. J Pediatr Orthop 26:617–623PubMedGoogle Scholar
  81. 81.
    Abel MF, Blanco JS, Pavlovich L et al (1999) Asymmetric hip deformity and subluxation in cerebral palsy: an analysis of surgical treatment. J Pediatr Orthop 19:479–485PubMedCrossRefGoogle Scholar
  82. 82.
    Miller F, Cardoso Dias R, Dabney KW et al (1997) Soft-tissue release for spastic hip subluxation in cerebral palsy. J Pediatr Orthop 17:571–584PubMedCrossRefGoogle Scholar
  83. 83.
    Noonan KJ, Walker TL, Kayes KJ et al (2001) Varus derotation osteotomy for the treatment of hip subluxation and dislocation in cerebral palsy: statistical analysis in 73 hips. J Pediatr Orthop B 10:279–286PubMedCrossRefGoogle Scholar
  84. 84.
    Turker RJ, Lee R (2000) Adductor tenotomies in children with quadriplegic cerebral palsy: longer term follow-up. J Pediatr Orthop 20:370–374PubMedCrossRefGoogle Scholar
  85. 85.
    Moen T, Gryfakis N, Dias L et al (2005) Crouched gait in myelomeningocele: a comparison between the degree of knee flexion contracture in the clinical examination and during gait. J Pediatr Orthop 25:657–660PubMedCrossRefGoogle Scholar
  86. 86.
    Westberry DE, Davids JR, Jacobs JM et al (2006) Effectiveness of serial stretch casting for resistant or recurrent knee flexion contractures following hamstring lengthening in children with cerebral palsy. J Pediatr Orthop 26:109–114PubMedCrossRefGoogle Scholar
  87. 87.
    Greene WB (2000) Cerebral palsy. Evaluation and management of equinus and equinovarus deformities. Foot Ankle Clin 5:265–280PubMedGoogle Scholar
  88. 88.
    Park ES, Kim HW, Park CI et al (2006) Dynamic foot pressure measurements for assessing foot deformity in persons with spastic cerebral palsy. Arch Phys Med Rehabil 87:703–709PubMedCrossRefGoogle Scholar
  89. 89.
    Kling Jr TF, Kaufer H, Hensinger RN (1985) Split posterior tibial-tendon transfers in children with cerebral spastic paralysis and equinovarus deformity. J Bone Joint Surg Am 67:186–194PubMedGoogle Scholar
  90. 90.
    Mulier T, Moens P, Molenaers G et al (1995) Split posterior tibial tendon transfer through the interosseus membrane in spastic equinovarus deformity. Foot Ankle Int 16:754–759PubMedGoogle Scholar
  91. 91.
    Piazza SJ, Adamson RL, Sanders JO et al (2001) Changes in muscle moment arms following split tendon transfer of tibialis anterior and tibialis posterior. Gait Posture 14:271–278PubMedCrossRefGoogle Scholar
  92. 92.
    Kagaya H, Yamada S, Nagasawa T et al (1996) Split posterior tibial tendon transfer for varus deformity of hindfoot. Clin Orthop Relat Res:254–260Google Scholar
  93. 93.
    Romanini L, Carfagni A, Amorese V (1983) Grice’s operation for spastic flat foot. Ital J Orthop Traumatol 9:439–449PubMedGoogle Scholar
  94. 94.
    Morrisroe SN, O’Connor RC, Nanigian DK et al (2005) Vesicostomy revisited: the best treatment for the hostile bladder in myelodysplastic children? BJU Int 96:397–400PubMedCrossRefGoogle Scholar
  95. 95.
    Duckett JW, Gazak JM (1983) Complications of ureterosigmoidostomy. Urol Clin North Am 10:473–481PubMedGoogle Scholar
  96. 96.
    Metcalfe PD, Cain MP, Kaefer M et al (2006) What is the need for additional bladder surgery after bladder augmentation in childhood? J Urol 176:1801–1805PubMedCrossRefGoogle Scholar
  97. 97.
    Gilbert SM, Hensle TW (2005) Metabolic consequences and long-term complications of enterocystoplasty in children: a review. J Urol 173:1080–1086PubMedCrossRefGoogle Scholar
  98. 98.
    Metcalfe PD, Casale AJ, Kaefer MA et al (2006) Spontaneous bladder perforations: a report of 500 augmentations in children and analysis of risk. J Urol 175:1466–1470PubMedCrossRefGoogle Scholar
  99. 99.
    Tarcan T, Onol FF, Ilker Y et al (2006) Does surgical release of secondary spinal cord tethering improve the prognosis of neurogenic bladder in children with myelo — meningocele? J Urol 176:1601–1606; discussion 1606PubMedCrossRefGoogle Scholar
  100. 100.
    McLaughlin TP, Banta JV, Gahm NH et al (1986) Intraspinal rhizotomy and distal cordectomy in patients with myelomeningocele. J Bone Joint Surg Am 68:88–94PubMedGoogle Scholar
  101. 101.
    Bergenheim AT, Wendelius M, Shahidi S et al (2003) Spasticity in a child with myelomeningocele treated with continuous intrathecal baclofen. Pediatr Neurosurg 39:218–221PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2008

Authors and Affiliations

  • David Douglas Cochrane
    • 1
  • Richard Beauchamp
    • 2
  • Carol King
    • 3
  • Andrew MacNeily
    • 4
  1. 1.Division of Neurosurgery Department of SurgeryUniversity of British Columbia and British Columbia’s Children’s HospitalVancouverCanada
  2. 2.Department of OrthopedicsUniversity of British Columbia and British Columbia’s Children’s HospitalVancouverCanada
  3. 3.Spinal Cord ClinicBritish Columbia’s Children’s HospitalVancouverCanada
  4. 4.Department of UrologyUniversity of British Columbia and British Columbia’s Children’s HospitalVancouverCanada

Personalised recommendations