The paralysis associated with myelomeningocele: Clinical and experimental data implicating a preventable spinal cord injury

D. S. Heffez, J. Aryanpur, G. M. Hutchins, J. M. Freeman

Research output: Contribution to journalArticlepeer-review

Abstract

Paralysis seen in children with myelomeningocele has been attributed to congenital myelodysplasia. We suspected that paralysis may be due in part to a spinal cord injury caused by exposure of the neural tube to the amniotic fluid. This hypothesis was tested using a fetal rat model of surgically created dysraphism. Each pup from the experimental group of rats in which the spinal cord was intentionally exposed to the amniotic fluid was born with severe deformity and weakness of the hind limbs and tail. Control fetal rats, subjected to the same procedure without directly exposing the spinal cord to the intrauterine environment, were normal at birth. Histological studies of the exposed spinal cord revealed extensive erosion and necrosis, findings similar to those described in children with myelomeningocele. We therefore propose a 'two-hit' hypothesis to explain the paralysis seen in children with myelomeningocele: congenital myelodysplasia complicated by an intrauterine spinal cord injury. Intrauterine protection of the exposed spinal cord might prevent some or all of the paralysis. The possible implications of these findings for the future treatment of myelomeningocele are discussed.

Original languageEnglish (US)
Pages (from-to)987-992
Number of pages6
JournalNeurosurgery
Volume26
Issue number6
DOIs
StatePublished - Jan 1 1990

Keywords

  • Amniotic fluid
  • Myelomeningocele
  • Spinal cord injury

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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