A historical review of the surgical treatment of spina bifida

Spina bifida or spinal dysraphisms have been present as long as man has walked the planet. A number of anthropological excavations have uncovered spines with stigmata typically seen in infants born with myelomeningoceles. As these children were born in an era where little or no treatment was available we can only assume that most did not survive. Having said that, there are a large number of surviving anthropological figures sculpted in stone, terracotta and other materials from early civilizations. These sculptures provide evidence of individuals who survived with what would be a normally devastating disease. Over the years the author has collected a number of terracotta figures from the Americas that show clear evidence of surviving children with stigmata of spinal dysraphism. These figures are seated in the typical position of a paraplegic child or adult with the typical lumbar kyphosis. Some of the figures have been incorrectly described as patients with tuberculosis or Pott's disease. A careful examination of these figures clearly shows the physical characteristics of individuals with chronic myelomeningocele. We have included several examples that come from Meso-American cultures where figures of this type are not at all uncommon (Figs. 1.1-1.5).