Functional orthopedic outcomes in children with myelomeningocele across the Indian Ocean region: a cohort study

Abstract

In patients with a myelomeningocele, ambulation and autonomy play a significant role in determining their quality of life and participation. The objective of this study was to describe functional orthopedic outcomes of children with myelomeningocele cared for or referred to a university hospital serving diverse regions in the Indian Ocean region, and to explore clinical factors associated with mobility and functional independence. This cohort study included children aged ≥ 2.5 years with postnatally repaired myelomeningocele who attended a cross-sectional functional and orthopedic assessment at the University Hospital of Reunion Island, in the first semester of 2024. Patients originated from Reunion Island, Mayotte and Comoros. Functional outcomes were evaluated by Functional Independence Measure (FIM) and New Functional Ambulation Classification (nFAC). Neurological, orthopedic and clinical data were gathered by standardized clinical examination and review of the medical record. Twenty-five children were included (median age 6.8 years [2.5–16.0]). 80% of patients had foot deformities and 52% had spinal deformities. Functional ambulation was achieved in 18 (72%) children and seven (28%) children remained non-ambulatory. Descriptive differences in ambulation were observed according to meningocele neurologic level with all children with sacral lesions achieving independent ambulation. Children who had undergone ventricular shunt placement had lower median nFAC scores (3 [0–7] vs. 7 [0–8], p = 0.009) and FIM scores (76 [23–116] vs. 112.5 [68–126], p = 0.01) than those without history of ventricular shunt placement. Children with sensory deficits at birth also had lower median nFAC scores (4 [0–7] vs. 7 [0–8], p = 0.05) and FIM scores (77 [51–116] vs. 106 [23–126], p = 0.04). This study provides one of the first descriptions of functional outcomes in children with myelomeningocele in a regional-based cohort from a low-middle income context. Mobility and functional independence were highly variable within the cohort. Orthopedic abnormalities remained very common. These findings underscore the complexity of long-term multidisciplinary care in this regional population.