Cerebrospinal hernia is an anomaly of intrauterine development, which is accompanied by the uninhibition of one or more vertebrae in the region of spinous processes, prolapse into the formed defect of the spinal cord and nerve roots.
The causes of the disease have not yet been studied, but recent medical research data point to a significant role in the development of the pathological process of vitamin deficiency, primarily folic acid.
The severity of the course of the disease and its consequences depend on the degree of damage to the spinal column and the volume of spinal tissue forming the hernial sac. The ability to diagnose pathology at the fetal stage of fetus allows for early termination of pregnancy or the appointment of radical treatment after the birth of a child to eliminate the development of severe disability.
From the type of pathological process in the vertebrae and the spinal cord depends the prognosis of the disease for recovery and full-fledged life, which determines the tactics of patient management.
Depending on the degree of anomaly, a child may receive a disability of varying degrees or not differ in full development from his peers.
The disease develops as a result of the developmental neural tube of the fetus, which subsequently forms the spine and spinal cord in the first months of pregnancy. The earlier the influence of unfavorable factors on organogenesis began( laying the future organs of the child), the more serious the consequences of a defect for physical and mental activity.
Classification of spinal hernia is based on the localization of pathology and the nature of changes in the lesion.
The localization of the disease is characterized by a hernia:
- of the cervical spine;
- of the thoracic spine;
- of the lumbosacral spine( found in 70% of cases).
On structural changes in the pathology site:
- latent splitting of the spine - accompanied by the uninhibition of one vertebra without the formation of a hernial sac, usually does not disrupt the normal development of the child;
- splitting of the spine with the formation of a hernia - a severe form of the disease, accompanied by a lesion of the spinal cord and brain, leads to impairment of motor activity, pelvic functions, mental development.
The herniated form of the disease is divided into species depending on the contents of the hernial sac:
- meningocele hernia contains the spinal cord, which usually does not lead to neurologic disorders;
- myelomeningocele - hernia includes the membranes and substance of the spinal cord, causes severe neurologic changes in the peripheral( paresis, paralysis) and central( hydrocephalus) nature;
- meningoradiculocele - hernial sac includes spinal roots, which leads to pathology of pelvic functions( incontinence of feces, urine);
- lipomeningocele - the hernia includes a benign tumor of the lipoma( sometimes fibroma), neurological symptoms may manifest as the child grows.
In most cases, the anomaly of the spine with the formation of a herniated spinal cord appears at the level of the lumbar region of
. The forms of the disease, which are accompanied by the formation of a hernial sac, especially containing the trunk of the spinal cord and its roots, require surgical treatment on the first day after the birth of the child.
Clinical manifestations of
Hidden splitting of the spine in most cases does not give specific symptoms in a newborn and can manifest itself in adulthood with intense physical activity. Often a congenital defect is detected in a diagnostic examination as a result of complaints of back pain in adult patients. The formation of a hernial sac is usually detected immediately after birth, in the absence of medical care, neurologic symptoms build up during the first years of life.
Cerebrospinal hernia is characterized by the following clinical manifestations:
- protrusion in the region of the spine round in a soft consistency, covered with a thin, shiny skin of a red or bluish tinge;
- muscular weakness of the upper or lower extremities, paresis and paralysis, the formation of flexural contractures( motor activity is reduced, legs and arms are in a bent position);
- violation of all types of sensitivity( pain, temperature, tactile);
- reduction of reflexes of the extremities up to full extinction( plantar, grasping, knee);
- atrophy of the muscles of the legs and hands;
- trophic disorders( dry skin, swelling, cold extremities, non-healing ulcers);
- changes in pelvic functions( delay or incontinence of feces and urine);
- leg defects( incorrect position of the feet, hips);
- hydrocephalus( edema of the brain) as a result of excessive intake of cerebrospinal fluid into the sinuses of the brain;
- epileptic seizures, visual impairment, mental retardation.
Schematic image of a spinal cord hernia
Patients with severe neurologic symptoms require constant care in the home, regular monitoring by medical personnel, and supportive treatment. Such patients are susceptible to inflammatory diseases of the internal organs. When urination is impaired, pyelonephritis develops, which causes severe renal failure. Fluid retention in the brain increases intracranial pressure, which leads to atrophy( death) of parts of the nervous tissue and development of the inflammatory process( meningitis, encephalitis).With prolonged bed rest, pneumonia( inflammation of the lungs), causing pulmonary-cardiac failure, appears.
Modern medicine conducts diagnostics of hernia of the spinal cord in the first months of bearing the fetus. If a woman becomes timely on the register and follows all the prescriptions of the doctor, the detection of a severe anomaly in the early stages of pregnancy can prevent the birth of a sick child. With significant defects in the spine and spinal cord, a woman is offered to interrupt pregnancy. In case of finding violations with a favorable prognosis for full development of the fetus, the operation to remove the hernia is performed after the birth of the child or even in the prenatal period, although this practice has not yet found wide circulation.
Diagnostic methods include:
- collection of anamnesis of the disease - clarification of complaints, examination of medical records with survey results and records of specialists;
- neurological examination - includes a visual study of protrusion in the spine, checking muscle tone and strength in the limbs, determining the intensity of reflexes of the hands and feet;
- transillumination - the transmission of a hernia to reveal the nature of the contents inside the saccate protrusion;
- computed tomography( CT) and magnetic resonance imaging( MRI) - allows a layered study of the spinal cord at the site of the pathology, to identify concomitant lesion of brain tissue;
- myelography is the detection of the extent of damage to the nervous tissue in the hernial sac by injecting a contrast agent into the peripheral vein and accumulating it in the pathology site.
Ultrasound on early gestation of the fetus allows diagnosing a herniated spinal cord
In the intrauterine period of the development of the fetus, an examination such as
- ultrasound prenatal examination( US), which is carried out according to the plan at different terms of pregnancy, can reveal an anomaly;
- analysis of future mother's blood for the content of alpha-fetoprotein( a protein entering the bloodstream when a nervous tissue is destroyed);
- amniocentesis( examination of amniotic fluid) by puncturing the membranes.
The decision on tactics and termination of pregnancy is made by a consultation of doctors, based on the severity of the pathology and consent of the pregnant woman.
Treatment tactics and preventive measures
Treatment of a spinal cord hernia is necessary by a radical method - the removal of congenital education in the spine by surgical means. To do this, reconstruct a defect in the spine and close the uninfected hole of the bone tissue. The hernial bag is examined for the presence of nonviable tissues, which are removed, and healthy structures of the spinal cord are placed in the vertebral canal. The disease is often accompanied by hydrocephalus, which eventually causes irreversible changes in the brain. To prevent the harmful effects of excess intracranial pressure, a shunt is formed that drains the cerebrospinal fluid into the breast lymphatic duct.
Conservative treatment of the disease is carried out as maintenance of the general condition and prevention of progression of the pathology.
- Preparations normalizing the work of nervous tissue( nootropics, neurotrophics).
- Vitamins B, C, E, A, improving metabolic processes in the affected parts of the spinal cord.
- Physiotherapy methods aimed at restoration of trophism of tissues and motor activity( magnet, laser).
- Therapeutic exercise for the development of neuromuscular connections in the affected areas of the body.
- Dietary nutrition, including a large amount of coarse fiber( vegetables, cereals) for the normalization of intestinal motility.
To prevent the appearance of malformations of the spinal cord, the spine several months before conception and in the first trimester of pregnancy, a woman is prescribed a daily intake of folic acid.
Herniated spinal cord refers to severe malformations of intrauterine development and can cause persistent disability, low social adaptation, the appearance of complications incompatible with life. To treat the disease is necessary surgically, but even a timely operation does not guarantee the normal development of physical and mental abilities. To prevent the appearance of an anomaly, you should correctly prepare for conception and undergo the necessary examinations under the supervision of the doctor during the fetal gestation.
- Clinical manifestations
- Treatment tactics and preventive measures