I. Overview
Spina bifida, also known as tetheredcordsyndrome (TCS), is a condition in which the spinal cord develops abnormally during the embryonic period, with local scar adhesions and shortened filaments, causing the spinal cord to become fixed at the site of the lesion and unable to adapt to the growth of the spine and rise, causing the spinal cord, cauda equina and filaments to be stretched, resulting in low back pain, bilateral lower limbs and dysfunction. The spinal cord, cauda equina and terminal filaments are stretched, resulting in low back pain, bilateral lower limbs and dysfunction.
Morbidity
The risk of patient morbidity is mainly related to the patient’s age, gender and general condition, male:female = 2:1; where there are urination, defecation disorders, lower limb sensory and motor disorders, foot deformities and other symptoms, physical examination found occult spina bifida, dominant spina bifida or had spinal bulge surgery, are suspected of this disease, once diagnosed as soon as possible surgical treatment; children with spinal bulge should be in the spinal cord embolism release at the same time for repair, surgery Injury to the cone and cauda equina should be avoided.
Causes
1. congenital factors embryonic spina bifida combined with spinal cord developmental malformations (such as spina bifida, spinal cord spondylolisthesis, spina bifida, local scar adhesions, end filament thickening, arachnoid cysts) or combined with lipoma, dermatomal cysts or epidermoid cysts, can cause the spinal cord fixed in the lesion site, can not adapt to the spinal elongation and rise.
2. Acquired factors post spinal surgery fiber adhesions can also cause spinal cord embolism.
IV. Pathology
1. Simple occult spina bifida is not combined with other spinal cord and neurological lesions.
2. Complex spina bifida is often combined with the above deformities, but also with hemivertebral body, scoliosis, intervertebral foramen and rib developmental deformities; the skin is mostly normal, but there may also be hair, pigmentation, lamellar capillary hemangioma, small concave skin and skin nevus.
V. Clinical manifestations
In light cases, there are weakness of lower limbs, mild muscular atrophy, numbness, urination, etc. There may be back pain and unilateral or bilateral muscle weakness of lower limbs, and physical examination shows low muscle tone, flaccid hypotonia and hyperalgesia of lower limbs and perineum.
In medium-sized cases, in addition to the above abnormalities, scoliosis, habitual hip dislocation, high arches, foot inversion and valgus deformity, and urinary incontinence may be combined.
3. In heavy cases, the muscle strength of the lower limbs is obviously reduced or even paralyzed, and the sensation is obviously reduced or disappeared, often accompanied by neurotrophic changes, coldness and numbness in the distal part of the lower limbs, trophic ulcers in the lower limbs and sacrococcygeal area, and even complete paraplegia and incontinence.
VI. Diagnosis
1. According to the above clinical manifestations, this diagnosis can be considered especially if there is long-term urine loss or occurrence of urinary incontinence and spina bifida is suspected.
2. X-ray spinal plain radiographs of the vertebral plates and spinal processes, multiple spina bifida or combined with vertebral deformities and scoliosis.
3. CT and MRI show spina bifida combined with spinal cord embolism (low cone position, local adhesions, may be combined with cysts or lipomas).
VII. Differential diagnosis
In terms of clinical manifestations alone, it is easily confused with lumbar strain, disc herniation, spinal cord tumor, spinal stenosis and other diseases, but detailed history, careful physical examination, especially CT and MRI of lumbosacral spine can be distinguished.
VIII. Treatment
Surgery is the main treatment modality, and it is emphasized that surgery should be performed as soon as possible once the diagnosis is confirmed. The purpose of treatment is to remove the abnormal lesion, release the spinal cord, cauda equina and compression, loosen the cauda equina of the spinal cord, and make the spinal cord rise. At present, early surgical treatment is mostly advocated to expand the vertebral plate decompression, remove the lesions and/or tissues (including abnormal or deformed bone, cartilage, thickened ligamentum flavum, and end filaments) that compress and pull on the dural sac, spinal cord, and cauda equina, and remove scar adhesions, lipomas, and cysts, generally without bone grafting and plate fixation, which can be supplemented with the application of neurotrophic drugs and vasodilators after surgery.
IX. Prognosis
At present, it is mostly advocated that surgical treatment should be actively created even if there is incontinence and lower limb paralysis.