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June 2, 1989

Exploring Causes of Paralysis in Spina Bifida

JAMA. 1989;261(21):3069-3074. doi:10.1001/jama.1989.03420210013007

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AN UNUSUAL CASE of spina bifida has set two neurosurgeons on a road that may eventually lead to a better understanding of events that cause the paralysis in this condition.

About 3 years ago, pediatric neurosurgeon Dan S. Heffez, MD, repaired a myelomeningocele in a 6-month-old infant. "In this particular case the typical malformed spinal cord seen in classic spina bifida was present but the cord, instead of being exposed, was covered by a full thickness of skin," he says.

"This is very unusual," Heffez points out. "It's only been reported once or twice before."

"But what was most important about this case was that there was no paralysis. So here was a patient with half the characteristics of a myelomeningocele; that is, the cord was structurally malformed and was outside the spinal column but—since it was fully covered by skin—it had not been exposed to the intrauterine environment."