Spina bifida patients generally tolerate orthopaedic surgery very well. Most problems arise from immobilization osteoporosis causing fractures and difficulties with internal fixation. Long periods of plaster immobilization should be avoided if possible. Great care should be taken when plastering to avoid pressure sores which can ruin an otherwise successful procedure.
The greatest cause of failure of surgery in the past has been the lack of realistic assessment of the child's potential. As a result, a technically successful operation turns out to be of no benefit to the child becuase he is unable to make adequate use of it. Therefore, orthopaedic management should aim to correct and prevent deformity in early life by conservative measures if possible. Once the general prognosis and likely functional ability of the child can be assessed, those deformities that are preventing him functioning to his maximum ability should be corrected by the minimum number of surgical procedures.