Spina bifida

Introduction Spina bifida is a rupture of the dorsal or ventral side of the spine due to congenital spinal dysplasia, with or without abnormalities of the meninges and nerve components. Clinically, such malformations are very common, accounting for 5% to 29% of the census population. Among them, the first and second atlas and the fifth lumbar vertebrae. The main reason for this is the developmental disorder of the cartilage center or the osteogenesis center in the embryonic stage, so that the bilateral vertebral arches do not fuse at the back to form a wide and narrow fissure. Simple bony fractures are called recessive spina bifida, the most common. If accompanied by meningocele or spinal cord bulging, it is dominant spina bifida, accounting for 1 2 , the latter is quite difficult to treat, and mostly in the category of neurosurgery.

Cause

1. At the third week of the embryonic period, the neural crests on both sides merge to the dorsal midline to form a neural tube, which starts from the middle (equivalent to the thoracic segment) and then develops at the upper and lower ends, and closes at the 4th week. After the neural tube is formed, it gradually separates from the epidermis and moves to the deep. The cerebral vesicles gradually form at the head end of the tube, and the rest develop into the spinal cord. At the 3rd month of the embryo, the spine component is formed by the mesoderm on both sides, and the canal is formed by wrapping the nerve tube in a ring shape. At this time, if the neural tube is not closed, the pedicle can not be closed and remain open, and can develop spinal meningocele.

2, the occurrence of spina bifida is related to a variety of factors, all kinds of abnormal factors affecting fertilization and pregnancy may contribute to the formation of such malformations. At the beginning, the spinal cord was as long as the spinal canal. After the third month, the position of the end of the spinal cord gradually increased due to the slower growth rate of the spinal cord than the growth rate of the spine. At the time of birth, the end of the spinal cord is at the level of the waist 3, and at the age of 1 year, it rises to between the 1st and 2nd lumbar vertebrae, and has remained at this section since then.

an examination

X-ray photographs, CT and MRI scans show spinal canal malformations, spinous processes and laminar defects, which contribute to the diagnosis of the disease.

Differential diagnosis

1. Diagnosis is not difficult. However, it is necessary to further judge the type of deformity, the central skin defect of the back and the severe nervous system symptoms, which is the spinal cord fissure. If it is a cystic mass, the light transmission test is positive, the nervous system is normal, the spine X-ray film only shows the posterior spine, suggesting simple meningocele; otherwise, it suggests the spinal meningocele; if the cystic mass deviates from the midline The symptoms of the nervous system are concentrated on one side, and the X-ray film of the spine shows the midline skeletal septum, the semi-vertebral body, the narrow intervertebral disc, etc., suggesting that the semi-lateral spinal meningocele.

2. This deformity still needs to be differentiated from teratoma, lipoma and dermoid cyst. This kind of tumor is more solid than the percussion, the pressure can not be returned, the light transmission test is negative, and the surface skin is normal, so the identification is not difficult. However, it should be noted that such tumors often coexist with spina bifida.

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