The outcome of 117 consecutive cases of open spina bifida treated unselectively from birth between 1963 and 1970 and reviewed 16-20 years later is reported from the Department of Urology, Addenbrooke’s Hospital, Cambridge, England. Forty-one percent died before their 16th birthday and most of the survivors were badly handicapped: 50% were wheelchair dependent, 30% were mentally retarded and 75% relied on an appliance or padding for incontinence. The majority had had a shunt inserted within hours of birth. 75% were incapable of employment and 50% were unable to live without help or supervision. The sensory level at birth provided a yardstick for predicting the range of handicap into adult life and was useful in counseling parents concerning the child’s long-term prognosis. With a sensory level above T11 the disability would be severe, with no prospect of walking or of continence and with a 10% chance of independent living. A sensory level between T11 and L3 (from the umbilicus to the knees) should indicate a moderate disability in 60% and a capability of living independently in 45%. A sensory level below L3 should predict a survival rate of 75% and a normal intelligence in 80%; 90% would be ambulant as adults and 45% would be continent; and 85% would be totally independent with moderate or minimal disability. [1]

COMMENT. The impact of treatment on disability is far less than that on mortality. In groups of patients treated selectively, the mortality among the untreated cases is higher and those selected for treatment are born with a much lesser degree of disability. Thoracic scoliosis and horseshoe kidney that may be recognized during fetal life are associated with sensory levels in the thoracic region and are predictive of a poor prognosis. The author points out that the reliable discrimination between mild and severe cases of spina bifida in early pregnancy is not yet possible and parents should be informed of the likelihood of prolonged dependency into adulthood.