Spinal Hernia In Newborns

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-07 17:49

Spinal hernia in newborns

Content:

• Reasons for the appearance of a spinal hernia
• Forms of spinal hernia in children
• Spinal hernia symptoms
• Diagnostics of the spinal hernia in children
• Spinal hernia treatment in children
• Postoperative therapy
• Spina Bifida Prevention

Congenital spinal hernia is a rare but severe developmental anomaly. This spinal cord defect occurs in only 0.1-0.03% of newborns, and about two-thirds of them remain disabled for life.

Modern means of prenatal diagnostics make it possible to find out about the presence of spina bifida even during pregnancy. For this, ultrasound data and additional analyzes for alpha-fetoprotein are used. The final confirmation occurs during the study of amniotic fluid - amniocentesis.

Reasons for the appearance of a spinal hernia

The question of the occurrence of a hernia of the spinal cord is not well understood. Because of this, various medical scientists call such factors that affect the likelihood of its occurrence:

• Deficiency of vitamins, and above all, folic acid (vitamin B9). It is recognized by most researchers as the main cause of the disease;
• A complex of factors provoking a variety of fetal anomalies: the intake of alcohol and other drugs during pregnancy, intoxication of the body, infection of the expectant mother with certain infections and parasites, etc.;
• Early pregnancy;
• Heredity.

The neural tube of the unborn baby is formed in the first eight weeks of pregnancy. It was at this time that the effect of the above factors can provoke insufficient infection of the posterior wall of the spinal canal. Because of this, one or more vertebrae are divided in the area of the spinous processes. In the resulting defect in the process of fetal development, hard spinal membranes, cerebrospinal fluid and even nerve roots can leave.

Forms of spinal hernia in newborns

Doctors distinguish between different cases of spinal hernias according to their localization and structural features. The location of the defect plays an important role for the patient and the doctor who treats him, since the severity of the symptoms and the complexity of the treatment of pathology depend on this.

The easiest type of splitting, in which there is no hernia as such, is called hidden (spina bifida occulta (lat.) - hidden spina bifida). In this case, a minor deformation of one of the vertebrae is diagnosed, which often does not cause inconvenience to the patient. In some cases, mild neurologic symptoms appear, but without significant health consequences.

A more serious defect in the structure of the spine provokes a hernial splitting. In this case, a protrusion extending beyond the limits of the skin is clearly noticeable. Most often, it consists of the meninges and fluid. In the most severe cases, the roots and the spinal cord itself enter the hernia cavity.

A hernia of the spinal cord can belong to one of three types of localization:

• In the cervical spine - the rarest type of hernia. Affects the upper spinal cord, which innervates the muscles of the neck, face and vocal cords. Accordingly, the coordinating abilities of these and all lower parts of the spine may be disturbed, which affects the motor activity of both the upper and lower extremities, as well as the heart and lungs;
• In the thoracic region - it happens more often than in the cervical, but still much less often than in the lumbar. Disorders of the neck, facial muscles and larynx are excluded, but, in addition to the limbs, the respiratory system and the heart, as well as internal organs (stomach, spleen, liver, duodenum 12) are at risk;

• In the lumbosacral region, it is the most common anomaly affecting the lower extremities, bladder and rectum, sometimes even the kidneys and genitals.

Regardless of where the splitting is located, the severity of the symptoms determines the degree of protrusion of the structures that make up the spinal cord.

According to it, the pathology is classified as one of four forms of spinal hernia:

• Meningocele is a mild form of the disease, which is characterized by penetration into the intervertebral defect exclusively of the spinal cord. The spinal cord itself remains properly formed and functional;
• Meningomyelocele - in addition to the membrane, there is a protrusion of the substance of the spinal cord. The structure of the neural tube is broken, neurological symptoms appear;
• Meningoradiculocele - in the hole formed by the deformed vertebrae, both the sheath and the roots of the spinal nerves extend outside the body, although the neural tube remains in place;
• Myelocystocele is the most severe form of anomaly, in which the spinal tissue from the inside is stretched by CSF (a special cerebrospinal fluid necessary to nourish the cells and tissues of the nervous system). As a result, the structure of the spinal cord is almost completely disrupted, which is difficult to restore and any treatment.

In addition to all the forms described above, in very rare cases, the most severe complication occurs due to the combination of a hernia with a tumor. Usually these are benign lipomas or fibromas fixed on the membranes, roots, or internal structures of the spinal cord. The degeneration of the tumor into a malignant formation does not occur, since it is removed along with the protrusion during surgery, or a fatal outcome occurs before this moment.

Spinal hernia symptoms

The manifestation of symptoms of spina bifida depends on the location, size and composition of the hernia. Of course, latent cleavage is characterized by the most insignificant external signs and the complete absence of neurological manifestations. The only symptom of such a pathology is a small notch at the site of the defect.

In terms of neurological symptoms, a hernia with a protrusion of only one shell can be said to be the same as about latent splitting. The only difference is that the hernia is a mass formation, not a depression. In some cases, this place is also marked by redness, shine or bluish color of thinned skin, as well as dark hair.

Neurological symptoms appear in the case of meningomyelocele,meningoradiculocele and meningocystocele. They arise due to disturbances in the structure of the spinal cord, which delays, distorts or completely stops conducting nerve signals.

These include:

• Lack of tactile and (or) pain sensitivity;
• Paresis, paralysis and malnutrition of the lower and, in rare cases, upper limbs;
• Dysfunction pelvic organs, in particular, the muscles of the bladder, anus and genitals.
• Impaired coordination of the heart, lungs, organs of the digestive and endocrine systems occurs rarely when it comes to hernia in the cervical or thoracic spine.

The above symptoms lead to secondary complications:

• Atrophy of paralyzed muscles, lack of their temperature regulation due to loss of skin sensitivity, edema, trophic ulcers on the skin of immobilized limbs;
• Flexion contractures (joint immobility, which eventually becomes irreversible);
• Bedsores in the buttocks and lower back;
• Fecal and urinary incontinence.

Diagnosis of spinal hernia in newborn infants

Accurate diagnosis of spinal hernia requires a complete physical examination, which begins with anamnesis. If you go to the doctor after giving birth,in which no pathologies were found, special attention is paid to age indicators during the period of manifestation of symptoms of the disease (weakness in the limbs, signs of atrophy and difficult muscle activity).

More: Causes and symptoms of muscle atrophy, diagnosis and treatment

The following diagnostic procedures are mandatory:

• Examination by a neurologist, during which motor activity is assessed, muscle tone of the limbs is checked, detection of protrusion and fixation of relevant medical indicators;
• Transillumination - a special light scan, thanks to which it is possible to detect and characterize the contents of a hernial protrusion;
• Contrast myelography is an intravenous injection of a contrast agent that accumulates in certain parts of the spinal cord. Gives an idea of the structure of the damage inflicted on the spinal cord in the process of hernia formation;
• Study of layer-by-layer images of magnetic resonance imaging or computed tomography of the spine, specifying data on disorders in the spinal cord and making it possible to predict further development of pathology;
• Consultation with a neurosurgeon in order to clarify the expediency of surgical intervention.

Treatment of spinal hernia in newborns < / h2>

The only recognized method of treating spina bifida with a spinal hernia is surgery. Surgical intervention in this case is required as early as possible, best of all - already in the first week of the patient's life. It is possible to prevent a threat to the life and health of a newborn only with the complete removal of the hernial sac and the elimination of the defect between the deformed vertebrae.

In some cases, with mild forms of the disease (meningocele of small size, which does not impair motor activity and sensitivity, as well as while maintaining normal skin), the operation must be postponed. Rapid surgery can damage important spinal structures, causing the same neurological disorders that need to be avoided. Any other spinal hernia requires urgent compulsory surgery.

Postoperative therapy

Any infant will need a long rehabilitation period to undergo such an operation. A newborn needs careful care, maintaining perfect hygiene, therapeutic massages, physiotherapy, gymnastics and prevention of constipation. The list of conservative measures also includes the prevention of pressure ulcers, training of the sphincters of the bladder and anus, treatment of spinal deformities and correction with support braces.

Usually, recovery from a spinal hernia occurs in one of two ways:

• After removal of the meningocele and all required rehabilitation procedures, the child's development continues normally. In most cases, these children grow up to be able to lead an active lifestyle.
• Elimination of hernia meningomyelocele, meningoradiculocele and meningocystocele can cause certain difficulties, both during and after surgery. Correct observance of the requirements of the rehabilitation period helps to avoid violations of the motor activity of the limbs, but one cannot expect the same from the functions of the pelvic organs. Urinary and fecal incontinence can last much longer than normal children. In adulthood, even if external signs of health persist, infertility is found in women, and erectile dysfunction in men.

Read more: Erectile Dysfunction in Men

Spina Bifida Prevention

Since a spinal hernia is a congenital developmental anomaly, the prevention of this disease is to eliminate its causes even before conception. The first step is to provide the unborn child with all the necessary trace elements and vitamins. Even if the pregnancy is unplanned, the use of drugs and appropriate foods can be started after conception - the sooner the better. In the specific case of preventing a hernia of the spinal cord, the emphasis is on vitamin B9 (folic acid). It is interesting that this substance can enter the fetus's body not only from the mother, but also from the future father, since it is transmitted through the seminal fluid, while exerting a significant effect.

Any expectant mother should consult a gynecologist and consult about diseases that develop at the stage of fetal formation. The doctor should talk about ways to ensure a favorable bearing of the child. For starters, most pharmaceuticals are discontinued for at least the first eight weeks, while the fetus forms a neural tube. Also, do not get carried away with cosmetics, the same applies to any household chemicals.

The author of the article: Volkov Dmitry Sergeevich | c. m. n. surgeon, phlebologist

Education: Moscow State University of Medicine and Dentistry (1996). In 2003 he received a diploma from the Educational and Scientific Medical Center of the Presidential Administration of the Russian Federation.