The degree of perineal sensation in a patient with open spina bifida correlates with different adverse outcomes. This can help identify patients who may require closer monitoring and more aggressive management. The authors are from the University of London.


Patient selection: open spina bifida, surgically closed soon after birth


Patient assessment: complete neurologic examination during infancy


Criteria for perineal sensation - all of the following:

(1) intact sensation to pinprick in >= 1 dermatome

(2) on one or both sides

(3) in the saddle area (S2 to S4)


Adverse outcomes that are more common in patients lacking any perineal sensation:

(1) renal death (see below)

(2) incontinence of urine and/or feces

(3) inability to walk at least 50 meters

(4) pressure sores


Patient at risk for renal death - both of the following:

(1) bilateral, symmetrical neurological deficit at or above L3

(2) absence of perineal sensation


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