The spinal cord defect associated with spina bifida is often associated with other malformations.

This results in a multisystemic process that leads to a vari­ety of health problems and potentially life-threatening complications. Motor and sensory deficits vary accord­ing to the level and extent of spinal cord involvement (23-25).

In the care of spina bifida patients, two levels are often described: the anatomic level of the lesion and the neurologic level of functional involvement. In terms of the level, it is the neurologic or functional level that gives health care providers prognostic information with respect to long-term expectations and functional outcomes. Spinal cord involvement may result in asymmetric motor and sensory deficits. Sensory defi­cits usually follow a dermatomal pattern and may not affect all sensory modalities equally (23,24).

Neurogenic bladder and bowel dysfunction may be present in all patients because of the distal level of innervation of the bladder and bowel. This is true even if there is no apparent motor involvement/deficit in the legs.

In the following discussion, clinical signs of mus­cle weakness are described. These levels are func­tional neurologic levels and may not directly reflect the anatomic level of the malformation.

Musculoskeletal deformities related to muscle imbalance may present serious clinical concerns. Deformities may be static deformities present at birth or may develop over the years.

Figure 9.1 summarizes segmental innervation, preserved muscle function, and musculoskeletal com­plications typical of various levels of spinal cord mal­formation. Providers must keep in mind that the overall functional outcome for the individual is related in part to neurologic level, in addition to other associated cen­tral nervous system and medical issues.