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Management of Orthopaedic Sequelae of Congenital Spinal Disorders
Michael Akbar, MD1; Bjoern Bresch, MD1; Thorsten M. Seyler, MD2; Wolfram Wenz, MD1; Thomas Bruckner, PhD3; Rainer Abel, MD1; Claus Carstens, MD1
1 Division of Spinal Cord Injury and Spine Center, Department of Orthopaedic Surgery and Rehabilitation Medicine, Ruprecht-Karls-University Heidelberg, Schlierbacher Landstraße 200A, 69118 Heidelberg, Germany. E-mail address for M. Akbar: michael.akbar@ok.uni-heidelberg.de
2 Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1070
3 Department of Medical Biometry and Informatics, Ruprecht-Karls-University Heidelberg, Neuenheimer Feld 305, 69120 Heidelberg, Germany
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2009 Nov 01;91(Supplement 6):87-100. doi: 10.2106/JBJS.I.00613
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Myelomeningocele (myelodysplasia or spina bifida) refers to a wide range of neural tube defects affecting the spine and spinal cord. These defects result from maldevelopment of the neuropore and the adjacent mesodermal and ectodermal structures during embryogenesis. Myelomeningocele can be classified as either open or closed according to the presence or absence of exposed neural tissue. Myelomeningocele occurs early during embryogenesis, resulting in a certain number of fetuses being spontaneously aborted1. In addition, advances in prenatal screening have led to an increase in the number of therapeutic abortions1-3. Because of the unknown numbers of spontaneous and therapeutic abortions, establishing the true incidence of myelomeningocele is very difficult. Epidemiological studies have revealed that the prevalence of myelomeningocele varies, depending on such factors as ethnicity, race, geography, and temporal trends1. It is estimated that over 4500 pregnancies per year are affected by this malformation in the European Union4, and approximately 3000 pregnancies per year are affected in the United States5. In 2005, the rate of myelomeningocele was 18.0 per 100,000 births in the United States6.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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