Spina bifida (spina bifida spine)

Spina bifida (spina bifida) is a defect in the closure of the spinal column. Despite the fact that the cause is unknown, low levels of folate during pregnancy increase the risk of this malformation. In some cases, there is an asymptomatic course, in others - severe neurological disorders below the lesion. An open spina bifida can be diagnosed prenatally with ultrasound or suspected of increasing the level of alpha-fetoprotein in the mother's serum and amniotic fluid. After birth, a defect is usually visually visible on the child's back. Treatment of spina bifida (spinal bifida) is usually surgical.

Cleft spine (spina bifida, spina bifida) is one of the most severe neural tube defects, compatible with the prolongation of life. Most often the defect is located in the lower thoracic, lumbar or sacral spine and, as a rule, covers from 3 to 6 vertebrae. The severity of the lesion varies from the latent, at which there are no obvious changes, to cystic protrusion (cystic spina bifida, spinal hernia), up to the fully open spine (rachischisis) with severe neurologic impairment and death.

With the latent cleft of the spine, skin anomalies appear that cover the lower back (usually in the lumbosacral section); they include fistulous passages with no visible bottom, located above the lower part of the sacral region, or located not along the midline; areas of hyperpigmentation and hair bundles. These children often have spinal cord anomalies below the defect site, such as lipomas and abnormal fixation of the spinal cord.

In cystic spina bifida (spinal bifida), the protrusion may contain spinal cord (meningocele), spinal cord (myeloceles), or both (meningomyelocele). With meningomyelocele, the hernial sac usually consists of meninges with a neural tissue in the center. If the defect is not completely covered by the skin, the hernial sac can easily rupture, which increases the risk of infection and development of meningitis.

Hydrocephalus often occurs with spina bifida (spinal bifida) and may be associated with type II Chiari syndrome or stenosis of the aqueduct. Other congenital anomalies may also be present, for example, disturbance of migration of neurons in the brain, syringomyelia and soft tissue formations.

[1], [2], [3]

Symptoms of spina bifida spina bifida

Many children with minimal spina bifida (spinal bifida) have no symptoms. With the involvement of the spinal cord and rootlets of the spinal nerves in the lumbosacral portion, which is usually present, paralysis of varying degrees develops in the muscles below the level of lesion. Absence or reduction of innervation of muscles also leads to atrophy of the legs and a decrease in the tone of the musculature of the rectum. Since paralysis develops in the fetus, orthopedic disorders can occur from birth (for example, clubfoot, arthrogryposis of legs, dislocation of hip joints). Sometimes there is kyphosis, which prevents the surgical closure of the defect and prevents the patient from lying on his back.

Also, the bladder function is disrupted, which leads to the appearance of a reverse urine cast and the development of hydronephrosis, frequent IMI and ultimately damage to the kidneys.

Diagnosis of bifida spina (spina bifida)

Methods of visualization of the spinal cord, such as ultrasound or MRI, are necessary; even in children with minimal skin manifestations, underlying abnormalities of the spine may be noted. An overview radiograph of the spine, hip joints and in the presence of indications of the lower extremities should be carried out together with ultrasound, CT or MRI of the brain.

After the diagnosis of spina bifida (bifida spine) is established, it is necessary to examine the organs of the urinary system of the child, including a general urine test, urine culture, a biochemical blood test with determination of the level of urea and creatinine and ultrasound. The measurement of bladder capacity and pressure, at which urine enters the urethra, can determine the prognosis and treatment tactics. The need for further examination, including the study of urodynamics and mictorial cystography, depends on the results obtained and the concomitant developmental anomalies.

[4], [5], [6], [7], [8]

Treatment of bifida spina (spina bifida)

Without rapid surgical treatment, the damage to the spinal cord and spinal nerves can progress. Treatment requires the combined efforts of specialists from several disciplines; in the beginning it is important to perform neurosurgical, urological, orthopedic, pediatric examinations, and also to invite a social worker. It is important to assess the type of defect, its location and extent; the state of the child's health and the associated developmental anomalies. Before the operation should discuss with family members their strengths, desires and opportunities, as well as the possibility of constant care and treatment.

Meningomielocele, found at the birth of a child, is immediately covered with a sterile napkin. If a spinal fluid flows out of the protrusion, antibacterial therapy is started to prevent the development of meningitis. Neurosurgical correction of meningomyelocele or spina bifida spina bifida (bifida spine) is usually performed within the first 72 hours after birth to reduce the risk of infection of the meninges or ventricles of the brain. If the defect is large or located in a remote location, you can consult with plastic surgeons in order to ensure adequate closure of the defect.

Hydrocephalus may require the operation of bypassing the ventricles of the brain in the period of newborn. The function of the kidneys should be regularly monitored, when an IMS occurs, proper treatment should be given. Obstructive uropathy due to obstruction of urine outflow from the bladder or at the level of the ureters should be actively treated to prevent the development of IMS. Early orthopedic treatment of spina bifida should be started (bifida spine). In the presence of clubfoot, a plaster bandage is applied. Hip joints are examined to identify a dislocation. Patients should be examined regularly to identify developing scoliosis, pathological fractures, pressure sores, as well as muscular weakness and muscle spasms.

Taking folates by women for 3 months before conception and the 1st trimester of pregnancy reduces the risk of neural tube defects.

What prognosis is the spina bifida spina bifida cleft (spina bifida)?

Spina bifida spine cleft (spina bifida) has a different prognosis; it varies depending on the degree of involvement of the spinal cord and the number and severity of the associated developmental anomalies. The worst-case prognosis with high defect localization (for example, thoracic spine) or in the presence of kyphosis, hydrocephalus, early development of hydronephrosis, combined congenital malformations. With appropriate treatment and care, many children feel good. Reduction of kidney function and complications of shunting the ventricles of the brain are typical causes of death in older patients.