Sixty-eight patients born with a myelomeningocele were studied in the second and third decades of their lives. All of them had had some orthopaedic surgery, an orthotic program, and other specialized medical and paramedical services. In the group with sacral-level lesions, half were community ambulators; in the group with lower lumbar lesions, a third; in the group with upper lumbar lesions, a tenth; and in the group with thoracic-level lesions, none. The most important factors that determine the ambulatory status of a child with myelomeningocele, besides the level of the lesion, are the motor power within a given neurosegmental level and the extent and degree of orthopaedic deformities.