Fixed spinal cord is a rare pathology that is characterized by a limitation of spinal cord mobility in the spinal canal. The disease is more often congenital in nature and is associated with intrauterine impairment of the proportion of development of the spinal cord and spine, as well as with post-traumatic and post-inflammatory scar-proliferative changes that lead to fixation of the spinal cord in the caudal region.
Normal spinal cord development
At the 3rd month of fetal development, the spinal cord occupies the entire length of the spinal canal. Then the spine is ahead of growth. At birth, the level of the final spinal cord corresponds to the level of the 3rd lumbar vertebra. At the age of 1-1.5 years, the spinal cord ends at the level of the 2nd lumbar vertebra in the form of a pointed cone. The atrophied part of the spinal cord continues from the apex of the conical sharpening and attaches to the 2nd coccygeal vertebra. Throughout the spinal cord is surrounded by meninges.
Spinal cord fixation
The spinal cord is fixed more often in the lumbosacral region, is stretched, and metabolic and physiological functions of neural formations occur. Neurological symptoms develop in the form of sensitivity disorders, decreased motor activity, pathology of the pelvic organs, etc.
The term was first voiced by Hoffman et al in 1976. A group of children was examined (31 cases). Identified violations of sensitivity and motor disorders, which were accompanied by a disorder of urination.
Causes of Fixed Spinal Cord
Any process that can fix the spinal cord and limit its mobility can cause the syndrome:
- Fatty tumors of the lumbosacral region.
- Dermal sinus - the presence of a communicating canal of the spinal cord with the external environment using the fistulous course. It is a congenital malformation.
- Diastematomyelia is a malformation in which a cartilage or bone plate departs from the back surface of the vertebral body, dividing the spinal cord in half. In parallel, a rough scarring of the terminal thread occurs.
- Intramedullary volumetric education.
- Syringomyelia is the formation of cavities inside the spinal cord. It is accompanied by pathological growth of the glial membrane.
- Cicatricial deformity of the terminal thread.
- Fixation of the spinal cord may be secondary and appear at the site of surgery on the spinal cord. It is observed after recovery of myelomeningocele.
The clinical picture and diagnosis of the syndrome
It is based on a thorough clinical examination of the patient, a neurological examination and is complemented by a set of instrumental studies. To expand the range of diagnostic search, neonatologists, pediatricians, surgeons, neurologists, neurosurgeons, orthopedists, urologists, infectious disease specialists are involved.
The age of the child determines the set of diagnostic measures.
Medical history
The history of newborns is poor and requires the expansion of diagnostic methods. In older children, impaired gait, muscle weakness in the legs, sometimes there is a difference in the muscle mass of the limbs, one of which seems thinner. There are urinary disorders in the form of urinary incontinence. In adolescence, skeletal deformity may appear, children suffer from frequent urinary tract infections, and this is due to a decrease in the tone of the bladder.
The most common symptom of the disease is persistent pain in the groin or perineum, which can spread through the spine and lower limbs. Often a pain symptom is accompanied by a violation of the sensitivity and tone of the lower limb.
Inspection
In the lumbar region you can find: a bundle of hair ("tail of the faun"), median nevus, local hypertrichosis, dermal sinus, subcutaneous fat tumor. These signs are the stigmas of dysembryogenesis.
Often there are skeletal deformities (scoliosis, kyphosis, asymmetry of the pelvic bones, progressive deformities of the feet), which occur in a quarter of patients.
The most important is a neurological examination, which allows you to identify the early signs of fixed brain syndrome in children. Paresis of the lower extremities of varying degrees is characteristic. In children under the age of 3 years, it is difficult to determine the depth of paresis, but it can be judged by the volume of motor disorders (there is no spontaneous activity). Outwardly, there may be signs of atrophy of the muscles of the extremities and the gluteal region, but if the child is overweight, this can hide the lesion. Violation of sensitivity is manifested in the form of a decrease or absence on the lower extremities, perineum and buttocks. Such children are prone to burns due to loss of sensation.
Disorder of the pelvic organs in the form of various disorders of urination (leakage of urine after emptying the bladder, false desires, involuntary urination), violation of the act of defecation.
Instrumental diagnostic methods
Supplement the data of anamnesis and clinical examination.
- Roentgenography. It is the initial research method for suspected damage to the spine and spinal cord. Inadequate in terms of research on soft tissue formations.
- Ultrasonography. A valuable method for diagnosing the disease in children under 1 year old.
- MRI The most sensitive method that allows you to study in detail the structure of spinal pathology.
- Computed tomography is informative only in cases where it is necessary to visualize the deformation of the skeleton before the upcoming operation.
- Urodynamic testing (cytometry, uroflumetry, electromyography). It is carried out for the diagnosis and postoperative control of children with fixed spinal cord syndrome.
Treatment of the fixed spinal cord in children
Therapy of fixed brain syndrome in children is engaged in a tandem of specialists. Children undergo a full examination every 3 months during the first year of life and every 6 months until adulthood. After that, the examination is carried out annually. Family members are warned that if the general condition worsens, the appearance of neurological disorders, violation of urination and defecation, you should go to the doctor unscheduled.
The main treatment method is neurosurgical. The sooner treatment is started, the more effective the result. The essence of the surgical intervention is the fixation of the spinal cord.
The results of fixed spinal cord surgery in children:
- pain regression (65-100%);
- improvement of neurological status (75-100%);
- reverse development of urological disorders (44-93%).
Orthopedic disorders require additional operational correction, for example, fixing the corrected deformity of the spine with a metal structure.
A high risk of an unsatisfactory result is observed in children with malformations of the divided spinal cord, lipomyelomeningocele. In such patients, secondary fixations of the spinal cord most often develop in places of surgical intervention.
Conclusion
Symptoms of a fixed spinal cord in children can be detected in utero with a planned ultrasound. These data allow you to prepare a born child for elective surgery at an early age.