NEUROLOGICAL OUTCOMES IN PATIENTS WITH SPINAL DYSRAPHISM: EARLY VS. LATE INTERVENTION

Abstract Background: Spinal Dysraphism encompasses a spectrum of congenital neural tube defects that can result in varying degrees of neurological impairment, including motor deficits and bladder/bowel dysfunction. Timely surgical intervention is often recommended to prevent progressive neurological decline; however, the optimal timing for surgery remains debated. Comparative studies evaluating early versus late intervention are limited, especially in developing healthcare settings. Objective: This study compares neurological outcomes in patients with spinal Dysraphism following early versus late neurosurgical intervention. Material and Methods:  A comparative cross-sectional study was conducted on 20 patients with spinal Dysraphism who underwent surgery at the Rawalpindi Institute of Health Sciences (RIHS) and Capital Hospital CDA between January and December 2024. Patients were divided into two groups: Group A (n=8) received surgery before age 13 (early intervention), and Group B (n=12) at age 13 or later (late intervention). Neurological outcomes, including motor and sensory deficits and bowel/bladder dysfunction, were assessed over a 1-year follow-up period. Results: Group A showed better neurological outcomes, with greater improvements in motor function, gait, and bladder/bowel control compared to Group B. These findings suggest that early surgical intervention may prevent progressive neurological deterioration and improve functional recovery. The small sample size and limited follow-up duration constrain the ability to assess long-term outcomes. Additionally, factors like coexisting anomalies, variations in surgical techniques, and surgeon expertise were not controlled and may have influenced results. Conclusion: This study adds to the limited comparative data on the timing of intervention in spinal Dysraphism. By evaluating adolescent and preadolescent surgical outcomes, it highlights the potential benefits of early intervention and underscores the need for further large-scale, longitudinal research in this area.