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Spina Bifida and the Total Care of Spinal Myelomeningocele

Martin P. Sayers, MD
JAMA. 1966;195(3):233. doi:10.1001/jama.1966.03100030127053.
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The diagnosis and management of spinal myelomeningocele is here treated with a thoroughness, familiarity with the literature, sympathy, and breadth of experience never before encountered in print. The author has crystallized his opinions with regard to terminology and offers useful suggestions regarding more uniform international usage. In discussing classification, incidence, heredity, and natural history, he accurately reviews and criticizes available data and opinion, which he then compares with his own experience.

The decision regarding initial treatment is analyzed first as a practical family and socioeconomic problem. "The decisions made about the back and the head in the first few months of life determine the whole fate of the child, not only the fact of survival itself, but, perhaps more important, the quality of the survivor." The decision to carry out early and intensive treatment is made when the team's assessment of the "child as a whole" reveals no contraindication, reasonable


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