Spinal dysraphisms

What is it?

Spinal dysraphisms refer to a broad group of malformations affecting the spine and surrounding structures. They are all a form of neural tube defect and occurs as the result from an event very early in an embryo’s development. Spinal dysraphism include many types, such as myelomeningocele, spina bifida occulta, split cord malformation (diastematomyelia), lipomyelomeningocele, dermal sinus tract, tight filum terminale, and tethered spinal cord.

Symptoms

The symptoms of spinal dysraphism vary by type:

  • Myelomeningocele can cause incontinence, hydrocephalus, tethered cord, sensory loss, orthopedics deformities, leg weakness, and paralysis.
  • Spina bifida occulta rarely causes symptoms.
  • Split cord malformation can cause structural scoliosis and tethered cord.
  • Lipomyelomeningocele: Symptoms are usually caused by the tethered spinal cord, such as problems with bowel and bladder function, urinary tract infections, spasticity, back and leg pain, weakness, and sensory loss.
  • Dermal sinus tract: Sometimes causes tethered cord.
  • Dermoid and epidermoid spinal cysts may cause neurological symptoms like weakness, clumsiness, and incontinence if they compress the spinal cord and nerve roots.
  • Tethered cord can cause leg weakness, sensory loss, orthopedic deformities, lower back and leg pain, and bowel or bladder incontinence.

Diagnosis

Depending on the severity of the condition, it can be detected at different points. Myelomeningocele or open spina bifida can often be diagnosed before the baby is born or immediately after birth. Other conditions such as benign tumors or spina bifida occulta may go undiagnosed for a while before any symptoms occur.

Treatment

Surgical treatment for spinal dysraphism varies by type:

  • In myelomeningocele, the defect that exposes the spinal cord to the outside world is repaired in the first days of life by restoring as much normal structure as possible, and then closing the membranes and skin over the spinal cord.
  • Spina bifida occulta does not need surgical repair if it causes no symptoms.
  • Diastematomyelia is surgically treated by decompressing the spinal cord.
  • Lipomyelomeningocele is treated by freeing the spinal cord from its attachment to the lipoma, removing as much of the lipoma as possible, and closing the membranes over the spinal cord.
  • Sinus tract is treated by removing the tract, and by untethering the spinal cord.
  • Tumors and cysts may be removed from the spinal cord with spinal surgery that involves operating microscope and very fine tools.
  • Tethered cord is treated by opening the spinal column from behind, and releasing the constriction.