Perineal sensation: an important predictor of long-term outcome in open spina bifida

Pippa Oakeshott ^1*, Gillian M Hunt ², Robert H Whitaker ³ and Sally Kerry ¹

¹ St George's, University of London, United Kingdom
² Addenbrooke's Hospital, United Kingdom
³ University of Cambridge, United Kingdom

^* To whom correspondence should be addressed. E-mail: oakeshot{at}sghms.ac.uk.

Accepted 12 August 2006

Abstract

Objectives: to see if perineal sensation in infants with open spina bifida is associated with a better long term outcome, particularly in terms of survival, renal related deaths and incontinence.

Design: 40 year prospective cohort study

Participants: Complete cohort of 117 consecutive cases of open spina bifida whose backs were closed non- selectively at birth between 1963 and 1971. Meticulous neurological examination in infancy showed 33 (28%) had perineal sensation defined as intact sensation to pinprick in at least one dermatome on one side in the saddle area S2-4).

Methods: We used data recorded within 48 hours of birth and during six reviews between 1972 and 2002. Details of deaths were obtained from medical records and the Office of National Statistics.

Results: By December 2005 57% (67/117) of the cohort had died. There were 50 survivors aged 38 (+/-3) years. The majority of those with perineal sensation survived (23/33 compared with 27/84 p<0.001). This difference was mainly due to 19 renal deaths in those lacking perineal sensation. Crucially there were no renal related deaths in those with perineal sensation (0/33 compared with 19/84 p=0.003). Among the survivors those with perineal sensation were more likely than the remainder to be continent of urine and faeces (10/23 compared with 1/27 p<0.001; 18/23 compared with 9/27 p=0.002). They were also more likely to be able to walk at least 50 metres (11/23 compared with 5/27 p=0.027) and never to have suffered from pressure sores (15/23 compared with 9/27 p=0.025).

Conclusions: Simple assessment of perineal sensation in infancy predicts long-term outcome in terms of survival, renal prognosis and incontinence in open spina bifida.

Keywords: cohort study, incontinence, long-term urological outcome, open spina bifida, renal deaths

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