A controlled trial of immediate and delayed closure of myelomeningocele.

Sharrard, Zachary, Lorber and Bruce (1963) in a study offorty children with spina bifida cystica, eighteen of whom survived three months, concluded that “operative closure of myelomeningocele should be regarded as a surgical emergency”. They believed that it was ethically unjustifiable to continue their controlled trial of treatment. Following this paper there was a wide acceptance of early closure and of the belief that this prevented increasing paralysis. However, there was a difference of opinion in our local hospitals about the correct treatment because several cases of myelomeningocele showed no improvement in muscle power after immediate closure. It was decided to conduct a prospective controlled trial of immediate and delayed closure of myelomeningocele to determine if immediate closure prevented or minimised muscle paralysis.