A layman’s explanation of spinal cord embolism syndrome and spina bifida The so-called embolism in spinal cord embolism syndrome means to be tethered or tied. I have an analogy for this disease. The lower end of the normal spinal cord has degenerated terminal filaments and cauda equina nerve roots etc. fixed to the inner wall of the end of the spinal canal, just like a cow with a rope fixed to a stone stake at one end bolted to its nose. Under normal circumstances, the rope is long and the cow has considerable freedom of movement and can breathe and graze freely etc. However, when the embryo is affected by some unfavorable factors early in its development in the mother’s body, the terminal filaments shorten or even the spinal cord itself adheres to the surrounding tissues. In mild cases, the cord is simply shorter than normal, limiting the movement of the nose; in severe cases, there is no cord at all, and the nose is buried directly in the mud and rocks (here it is also clear that spinal cord embolism, although congenital, is not a genetic disease). The tethering of the spinal cord causes damage to the nose and prevents normal breathing and grazing, while the tethering of the spinal cord affects the blood supply and strains the spinal cord, causing two main clinical manifestations: urinary and fecal dysfunction; and motor and sensory impairment of the lower extremities. The former causes a series of problems such as renal dysfunction and even life-threatening effects (except for the other aspects of spinal cord tethering, which are often not fatal), while the latter causes lower limb movement disorders, deformities, pain and hypoesthesia. After reasonable and scientific surgical treatment of spinal cord embolism syndrome, the prognosis of the disease depends mainly on the disease itself, and the following continues with the analogy of the bull’s nose. The natural way to free a tethered bull’s nose is to cut off what is tethered to it. For a short rope, the freedom of the bull’s nose can be restored if the rope is found and cut off, but in the case of a bull’s nose buried in mud and rocks, if you do not want to hurt the bull’s nose, you can only dig it out together with the rocks and the bull’s nose, so that the bull’s nose, although gaining some freedom, will be stuck somewhere else at any time. The same situation exists in the human body. If there are adhesions directly below both the spinal cord ends and nerve roots, etc., then such release may be difficult to complete or new adhesions may form after surgery, thus not providing continuous relief. The sequelae of spinal cord embolism syndrome and spina bifida have, as their clinical manifestations, two main aspects: urinary and fecal dysfunction and lower extremity motor impairment and deformity. In general, the presence of urinary and fecal dysfunction is a sign of a poor prognosis, because even if the surgical release is very satisfactory, its recovery is not always optimistic, especially for a long time, and this dysfunction may stay with the patient for the rest of his life. Painful symptoms in the lower extremities can often be relieved after surgery, and movement disorders may be recovered if they are not complete and the surgical release is satisfactory and no new adhesions are formed, but deformities that have formed need to be corrected surgically or by other means. Many people think that early surgery will solve the problem (including many neurosurgeons), but in fact some children with severe cases have irreversible neurological damage in the mother’s womb and are born with abnormal bowel and lower extremity function. Surgery at this time is not likely to be very helpful in restoring bowel and stool dysfunction, but it may help with lower extremity movement. In addition, many surgeons in the early stages of surgery focus on resolving the shape and neglect to address the neurological embolism and other lesions, and surgery at this time does not help to prevent its sequelae. However, urinary function is a problem that needs to be properly addressed, and it is recommended to see a specialized urologist, preferably one who has studied neurogenic bladder and urinary incontinence! Therefore, the rational and scientific treatment of spina bifida and spinal cord embolism syndrome and the related disorders they cause should be multidisciplinary (neurosurgery, urology, orthopedics, etc.), it is congenital and a disease that may require lifelong attention! Disease-related social information The incidence of neural tube malformation in China is decreasing year by year ———————————————- Neural tube malformation is a collective name for a series of diseases such as anencephaly and spina bifida. It is the disease with the highest incidence of birth defects among infants in China. Since the implementation of the Birth Defects and Malformations Prevention Intervention Program in 1997, the incidence of neural tube malformation in China has been decreasing year by year, and by 2000, the national project implementation area has been reduced by 40% on average. Liu Hongwei, a rural woman in Hebei who had a deformed child, had her greatest wish to have a healthy child. 5 months ago, her wish finally came true, as the national intervention program to prevent birth defects and malformations by taking folic acid made her dream come true. At present, 27 provinces, cities and autonomous regions have been covered by the program nationwide, and more than 50 percent of all families are aware of taking folic acid before and after pregnancy. Chen Xin, researcher at the China Women and Infants Health Center of Peking University: According to statistics, the incidence of birth defects in China is 13.05%, with more than 400,000 defective children born each year, including the highest incidence of neural tube abnormalities, with about 100,000 cases each year. Scientific research has confirmed that the lack of folic acid in women of childbearing age is the main cause of neural tube abnormalities in infants, and timely supplementation of folic acid under the guidance of doctors can reduce the occurrence of neural tube abnormalities in 85% of cases. Professor Li Zhu, Director of the Institute of Reproductive Health, Peking University, led a study on the promotion of folic acid supplementation for women to prevent neural tube abnormalities, which was awarded by the National Key Science and Technology Research Program of the Ninth Five-Year Plan of four ministries. ———————————————- Neural tube malformation, mainly including anencephaly and spina bifida, is a common birth defect in China and a serious public health problem worldwide. Through the evaluation study of the effect of folic acid supplementation on the prevention of neural tube malformation in 250,000 women in four provinces of Shanxi, Hebei, Jiangsu, and Zhejiang, this project has demonstrated for the first time in the world that the daily supplementation of 0.4 mg of folic acid alone before and after pregnancy can effectively prevent the first occurrence of neural tube malformation in women, with a prevention rate of 85% in high incidence areas and 40% in low incidence areas. The results were recognized internationally and are now used in more than 40 countries.