Paediatric spine diseases are deformities of the spine that occur in children during embryonic development, at birth or during early or late childhood stages. There are several different types of paediatric spine diseases and the symptoms vary according to the child’s age of onset, severity and type of deformity.
Some common types of paediatric spine diseases are spina bifida (meningocele & meningomylocele), tethered cord syndrome.
Spina Bifida
Spina bifida is condition which occurs due to a birth defect called the neural tube defect. The neural tube is a structure in the developing baby which leads to the formation of the brain, spinal cord and surrounding tissues. Incomplete closure of the neural tube results in defective formation of the spinal cord. Spina bifida may cause mild to severe disabilities depending on the size and location of the defect. There are mainly three types of spina bifida, they include: meningocele, myelomeningocele and spina bifida occulta.
Spina Bifida Occulta
It is a mild form of spina bifida with a small gap in between the vertebrae of the spine. Spina bifida occulta does not cause any serious health issues or disabilities. In most cases, spina bifida may never be diagnosed until diagnostic imaging scans are taken for other unconnected reasons.
Meningocele
It is a form of spina bifida which causes protrusion of a fluidic sac through the spinal column from an opening in the back region of the baby. This fluidic sac does not contain the spinal cord and may lead to little or no nerve involvement. This form of spina bifida may cause mild disabilities.
Meningomyelocele
This is the most severe form of spina bifida which causes protrusion of a fluidic sac through the spinal column, with involvement and damage of spinal nerves and parts of the spinal cord within the sac. This form leads to a range of moderate to severe disabilities such as loss of sensation in legs or feet, difficulty in moving legs, bladder and bowel issues, muscle weakness etc.
Causes and risk factors of Spina Bifida
Although the clear-cut causes of spina bifida are unknown, there may be some associated factors during pregnancy which can cause spina bifida. They include:
- Genetic factors
- Folic acid deficiency
- Environmental factors
- Exposure to viruses and radiation
- Certain medications
- Uncontrolled diabetes
- Obesity
- Elevated body temperature.
Precautions to be taken during pregnancy to prevent Spina Bifida
Here are some measures that can be taken during pregnancy to prevent spina bifida:
- It is recommended to take 400mcg of folic acid daily.
- Consult your doctor before taking any medications or dietary supplements.
- Blood sugar levels and body weight must be under control.
- Prompt treatment of any fever.
- Overheating of your body by any means must be avoided.
Tethered Spinal Cord Syndrome
Tethered Spinal Cord Syndrome is a condition which involves abnormal attachment of the spinal cord within the spinal canal, preventing free movement of the spinal cord. This can eventually lead to stretching of the spinal cord during growth, which may cause nerve damage. Tethered Spinal Cord Syndrome is frequently seen in children with Spina Bifida.
Causes and risk factors of Tethered Spinal Cord Syndrome
The following are some of the causes of tethered spinal cord syndrome:
- Often associated with Spina Bifida (myelomeningocele)
- Lipomeningocele
- Congenital anomalies at the tail of the spinal cord
- Dermal sinus tract
- Split spinal cord
- Thickened fibrous tissue near the tailbone
- Genetic factors
Signs and symptoms of Tethered Spinal Cord Syndrome
Some of the common signs and symptoms of tethered spinal cord syndrome include:
- Back and leg pain
- Numbness and tingling sensation in legs
- Discoloration of skin in the lower back region
- Fatty mass/dimple on the lower back
- A patch of hair in the lower back region
- Weakness of legs
- Pain and tenderness of the spine
- Abnormal spine curvature
- Bladder and bowel difficulties
- Worsening back pain with activity
- Walking difficulties
- Foot, leg and spinal deformities
Diagnosis of Paediatric Spine Diseases
Causes and risk factors
(Spina Bifida-meningocele, meningomylocele & Tethered cord syndrome)
Spina Bifida can be diagnosed based on prenatal screening tests and maternal blood tests. Prenatal screening tests may include ultrasound and amniocentesis.
Ultrasound is a process which uses high frequency sound waves to obtain images of the spinal cord and other parts of the developing baby during pregnancy.
Amniocentesis is a process through which a sample of the amniotic sac fluid is taken for examination to rule out genetic factors.
Maternal blood tests may include Maternal Serum Alpha-Fetoprotein (MSAFP) test to assess the levels of a protein produced by the baby in the mother’s blood.
Tethered Spinal Cord Syndrome may be diagnosed using diagnostic imaging scans such as MRI, CT scan, Myelogram or ultrasound.
Treatment of Paediatric Spine Diseases
(Spina Bifida-meningocele, meningomylocele & Tethered cord syndrome)
Treatment of spina bifida depends on the type and severity of the condition. Considering these factors, doctors may decide on surgeries before birth, surgeries after birth, or type of delivery such as a caesarean delivery. Other treatment methods during childhood may include walking and mobility aids, bowel and bladder management, surgery for hydrocephalus and management of other associated complications.
Tethered cord syndrome is treated with surgery. The type of surgery is determined based on the causative factors and specific symptoms.
