Spinal hernia and back pain

It is known that congenital malformations of the spinal cord (myelodysplasia), as a rule, are combined with any of the variants of the vicious development of the spine. The most frequent and most studied variant of myelodysplasia is spinal hernia.

Spinal hernia - a combination of vertebrae and spinal cord defects, including a defect forming the spinal canal bone structures, swelling in this defect of the spinal cord and its elements. Spinal cord hernias have anatomical and clinical-anatomical classifications. In the first case, the localization and contents of the hernial sac are usually taken into account. In the second case, the anatomical version of the defect is usually not detailed, and the determining factor is the nature of the clinical manifestations and complications - sensory and / or motor disorders, violations of pelvic functions. In the classification proposed by K.L. Dreyer (1973), two variants of spinal hernias are identified: a shell spinal hernia that is not accompanied by disturbances in the function of the spinal cord, and a cerebral cerebrospinal hernia that occurs with the phenomena of paresis or paralysis. The accumulated information on the anatomy of cerebrospinal hernia has allowed us to distinguish various anatomical variants of the defect.

RE Lindseth (1996) considers spinal hernias as a particular variant of neural tube defects, united by common terms spinal bifida aperta, and also categorizes neural tube defects and their complications.

The variety of complications of defects in the neural tube necessitates a primary search for a patient with cerebrospinal hernia to search for concomitant anomalies of the vertebrae, vertebral canal and spinal cord (including diastematomyelia, various variants of spinal cord fixation, Arnold-Chiari syndrome).

Especially we note a fundamental change in views on the treatment of spinal hernia, which occurred in the last twenty years. Previously, the presence of neurological disorders and back pain was considered an absolute contraindication to surgical treatment. From modern positions, their presence is not a contraindication either to the surgical treatment of the hernia itself, nor to the treatment of concomitant defects of the spinal cord and spine. In some cases, the operation allows not only to facilitate the care of the patient, but also to improve the quality of his life. The order of operations is dictated by the following principles:

• elimination of concomitant spinal cord defects should be carried out simultaneously with the main plastic surgery for spinal hernias;
• Concomitant orthopedic defects and complications, including deformity of the spine, must be eliminated after the main intervention.

Malformations of the neural tube 

Anatomical variants of neural tube defects
Meningocele	A skin hernia without including any elements of the spinal cord in its contents. As a rule, a purely cosmetic defect, not accompanied by neurologic disorders or orthopedic complications.
Myelomeningocele	Cerebrospinal hernia, the contents of which are elements of nervous tissue. Typically, the presence of peripheral neurological disorders, as well as pathologies of the central nervous system, including hydrocephalus and the Arnold-Chiari anomaly.
Lipomeningocele	Cerebrospinal hernia, the contents of which is a lipoma, intimately intertwined with elements of nervous tissue. Neurological disorders are often absent at birth, but can develop during growth, not spreading above the lumbosacral level.
Rakhishizis (rahishisis)	Defect of tissues ,. Covering the dysplastic spinal cord, usually including the absence of skin, muscles (it is possible to preserve the thinned padding), bone structures and the hernial sac itself.
Complications of neural tube defects
Neurological	Paresis and paralysis (spastic and flaccid), dysfunction of the pelvic organs, impaired sensitivity.
Neuroorthopedic:	Deformations of the spine Scoliosis. Marked in 100% of cases with paraplegia from the thoracic level. In 85% of cases the deformity exceeds 45. C-shaped scoliosis is typical for pure neuromuscular deformities, S-shaped scoliosis more often indicates concomitant hydromyelia, syringomyelia, or tethered cord syndrome. The lordosis. They are rarely seen, often associated with contractures in the hip joints. Kyphosis. They are noted in 8-15% of patients with myelomeningocele, often already at birth exceed 80 ° and progress during growth. Hip Dislocation Contracture of knee joints Deformations of the foot Charcot's arthropathy (progressive neurotrophic degeneration of the joints)
Complications from the shells of cerebrospinal hernia	Inflammation of membranes and rupture of membranes
Fractures of hip and leg bones

[1], [2], [3], [4], [5]