Sensory and mobility complications of L5 lesion

By Ludo

Paralysis and loss of sensation
In the case of myelomeningocele the spinal cord protrudes from the spine throughout pregnancy and is closed by surgery shortly after birth. As a result the spinal cord is almost invariably damaged and defective, the nerves being disorganised and broken. As a result messages from the brain (controlling and initiating movement) and those from the body to the brain (giving the sensations of touch, pain and position) are impaired. However, paralysis, muscle weakness and loss of sensation occur only at the level of the lesion and downward. Due to lack of skin sensation and decreased mobility, skin tissue breakdown may occur resulting in pressure sores. In most cases the head, upper trunk and arms are not affected. The level of impairment varies considerably depending on the amount of damage and the location of the lesion.

Movement & gait

The extent of the lesion provides a good estimate of the extent of lower limb functioning.
Of course, every individual is different, and each person with SBH is affected slightly differently.
Because nerves are affected at and below the point at which malformation occurs, the higher up the spine it occurs, the greater the paralysis (immobility) of the lower limbs will be.
Most people with SBH will need leg braces or more help to walk. Braces can help to support and protect weak muscles or joints.
Sometimes people will use braces or crutches for short distances, and use a wheelchair when they are more likely to get tired, or to leave their hands free.
Most individuals will need one or more orthopaedic (bone or joint or soft tissue) operations over the course of their life to assist in maximising function.
The level of paralysis should not change as the person with SBH gets older. A range of problems, however, commonly occur throughout life. These include:

scoliosis (spinal curving due to muscle imbalances) which requires surgery.

tethered cord (the scar tissue where the lesion has been repaired “sticks”, not allowing the spinal cord to move) which causes a range of problems and also requires surgery.

T12 & above With braces, can only walk short distances; with walker or crutches, slightly longer. Will mostly use a wheelchair, even in childhood.
L1 – L3 Leg braces with a waistband; will use crutches. Wheelchair for distances
L4 Will usually need braces, perhaps above the knee; crutches or cane; wheelchairs when older
L5 – S Short leg braces; may need crutches or cane.

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~ by pcl4 on October 15, 2008.

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