Orthopedic approaches to the management of locomotor deformities in children with Spina Bifida: a systematic review of the pediatric medical literature

This systematic review evaluates orthopedic approaches for managing locomotor deformities in children with spina bifida, analyzing 43 studies (2004-2024) following PRISMA guidelines. The findings reveal that 58% of patients develop clubfoot (92% in thoracic-level lesions), 42% hip dislocation (71% above L4), and 61% scoliosis in thoracic cases. Surgical interventions showed superior anatomical correction (RR 1.8) but carried substantial complication risks (24-31%), while conservative approaches like modified Ponseti technique achieved 87% initial clubfoot correction with fewer complications (12%). Three critical prognostic factors emerged: early intervention (40° curves. Major limitations include retrospective bias (78% studies) and insufficient long-term functional data. Future research priorities comprise: 1) RCTs comparing emerging technologies (smart braces, VR rehabilitation), 2) cost-effectiveness analyses of magnetic growth rods, and 3) international registries tracking adult outcomes. This synthesis advocates for a paradigm shift from deformity-focused to function-optimizing care, integrating surgical precision with lifelong multidisciplinary support to improve quality of life in this vulnerable population.