Myelomeningocele is a congenital disorder of the lower spinal cord that can cause asymmetric muscle weakness and lack of sensation in the legs. The level of involvement ranges from high thoracic or upper lumbar — with no capacity for independent ambulation — to lower lumbar, where walking with braces and crutches is possible, and sacral level with good leg function. Hip dislocation is more common at proximal levels.
Management by Level of Involvement
| Level | Function | Hip Treatment |
|---|---|---|
| Sacral | Walk without waddling | Treated like idiopathic DDH with standard reduction |
| Low lumbar | Ambulate with AFOs and crutches; lack hip abductors | Hips left dislocated — do not benefit from reduction. Focus on correcting contractures and leg length difference. |
| Higher levels | No independent ambulation | Hip dislocation does not require treatment beyond releasing contractures and preventing pressure sores. |