Meningomyelocoele

herniation of the spinal cord and meninges through a defect in the vertebral canal. This defect is also known as myelomeningocoele and may occur in spina bifida or spinal dysraphism. The origin of meningomyelocoele is not completely known. This defect is the most common cause of neuropathic osteoarthropathy in children, in whom the ankle and tarsal joints are the primary sites of involvement.

Findings include osteoporosis, fractures of the diaphysis and metaphysis, growth plate injuries, epiphyseal separation, effusions, joint destruction and soft tissue ulceration. In addition, vertebral hypoplasia, hemivertebra, laminar and pediculate fusion, diastematomyelia, kyphosis, scoliosis, pes cavus deformity and lipoma may all be associated with the myelomeningocoele.

On imaging, the expanding neural and meningeal mass causes reorientation of the laminae from an oblique to a sagittal or even coronal plane. CT scanning, with or without the administration of contrast agents, or MR imaging is necessary to show the vertebral and neural abnormalities. Kyphosis is present in about one fifth of patients. The status of the urinary tract should be evaluated at standard intervals with cystography, urography and ultrasonography. Also, see meningomyelocele.