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Indian J Case Reports 163 Meningomyelocele (MMC) is a congenital malformation of the spine, spinal cord, and overlying meninges that is known to affect 1 in 500–1 in 2000 live-born infants [1]. It is the most common open neural tube defect characterized by failure of the neural tube to close in the lumbosacral region during embryonic development (4th week post-fertilization), leading to the herniation of the meninges and the spinal cord through a vertebral defect [2]. The neural tube fusion starts at the level of the hindbrain (medulla and pons) and progresses rostrally and caudally. Incomplete fusion caudally leads to the formation of MMC around day 26 of gestation [3]. Prenatal triple screening for an elevated alpha-fetoprotein level during the first trimester is diagnostic in 85% of cases. Ultrasound is also very effective in screening for neural tube defects. The cause of myelomeningocele is unknown, but a deficiency in folic acid is believed to have a role in the pathogenesis of these neural tube defects [1]. The neurologic lesion produced by the MMC is variable and depends on what neural elements have everted with the meningocele sac. The bony vertebral level often provides little or no clue of the exact neurologic level or lesion produced. The height of the bony level may differ from the highest extent of the neurologic lesion for one to three vertebrae in either direction [4]. The neurologic lesion produced by this condition influences the lower urinary tract (LUT) function in a variety of ways and cannot be predicted just by looking at the spinal abnormality or the neurologic function of the lower extremities. We report a case of a 54-year-old male with lumbosacral MMC, who was asymptomatic till about 6 months ago and presented with urinary voiding complaints following a fall and sustaining an injury to the back.

MENINGOMYELOCELE IN A 54-YEAR-OLD MALE: A CASE REPORT OF LATE PRESENTATION OF VOIDING SYMPTOMS