Skin sinus

Introduction Patients with tethered cord syndrome, especially children, should be alert to the clinical manifestations of the sinus or subcutaneous mass. Tethered cord syndrome (TCS) is a syndrome in which a spinal cord or a cone is pulled due to various congenital and acquired causes, resulting in a series of neurological dysfunctions and malformations. Because the spinal cord is pulled more often in the lumbosacral medulla, causing the cone to be abnormally low, it is also called the lower spinal cord. Dorsal dermal sinuses of congenital origin: These sinuses are caused by the inability of the neural tube to separate from the surface-embedded skin. The sinus is common in the lumbosacral region, the head and the chest; most of them are only deep depressions, and the true sinus is rare; the skin at the sinus can be normal, hairy or hemangioma, may be associated with spina bifida; sinus As an entrance can cause meningitis, abscess and osteomyelitis, the sinus caused by the skin-like cyst can cause compression symptoms. If the central nervous system infection or compression symptoms are caused by the sinus, surgery should be performed.

Cause

1. Various congenital spinal dysplasia

Such as meningocele, spinal cord fissure, spinal meningocele, etc. due to insufficiency of the end of the neural tube. Most of the cases after birth were repaired within a few days. The purpose was to repair the abnormal nerve tissue as normal as possible. It is important to prevent cerebrospinal fluid leakage, but after the spinal dural tube is rebuilt. The adhesion produced during the healing process causes tethering at the end of the spinal cord.

2. Spinal cord lipoma and dural and extrahepatic lipoma

It is caused by the premature separation of the neuroectodermal and epidermal ectoderm, and the adipocytes of the mesodermal leaves enter the neuroectodermal leaves that are not yet blocked. Adipose tissue can enter the center of the spinal cord, or it can be connected to the subcutaneous fat tissue through a separate vertebral arch to fix the conus of the spinal cord. Moreover, the cases after the early childhood are related to the inflammation of the fat existing in the subarachnoid space, resulting in fibrosis around the nerve roots and adhesions caused by tethering.

3. Latent sinus

It is the neuroectodermal and epidermal ectoderm that are not well differentiated, and the locally formed cord-like tissue from the skin through the subcutaneous, spinal, causing tethering to the spinal cone. It can also be proliferated by the tissue of the latent sinus wall to produce dermoid cysts and epidermoid cysts and teratomas, which can surround or pull the spinal nerves and cause tethering.

4. Spinal cord longitudinal fissure

The mechanism of the occurrence of longitudinal fissures of the spinal cord is thought to be caused by abnormalities other than nerves, that is, the abnormal development of the vertebrae; it is also considered to be an abnormal occurrence of nerves, which is followed by abnormalities in the development of the vertebrae. The spinal cord is separated from the left and right, with a dural tube with both split and non-dividing types. That is, type I: double dura capsule double spinal cord type, that is, the spinal cord is in the longitudinal fissure, completely separated by fibers, cartilage or osteophytes, divided into two, each with its dura mater and arachnoid, spinal cord partition Pulling, causing symptoms. Type II: the common spinal capsule double spinal cord type, the meninges in the longitudinal fissure, separated by fiber septum, 2 parts, but there is a common dura mater and arachnoid, generally no clinical symptoms.

5. The end of tension

It is due to the process of degeneration of the terminal end of the spinal cord, which is degenerate to form a terminal filament, which causes the terminal filament to be thicker than the normal terminal filament, and the remaining part causes the tethered cord.

6. Neurogenic intestinal cyst

The so-called neurogenic intestinal cyst is a state in which the mesenteric margin of the intestine and the tissue in front of the spine form a traffic due to the patent of the notch of the spinal cord. According to the degree of patent ductus arteriosus and communication, there may be manifestations of bone defects associated with the anterior spine, called the intestinal fistula and the intestinal cyst inside and outside the spinal canal.

7. Postoperative complications such as lumbosacral sulcus

Some scholars estimate that this can account for 10% to 20% of all surgical cases.

an examination

Related inspection

Blood routine spine MRI

The clinical manifestations of tethered cord syndrome are more complicated. Because patients with tethered cord syndrome have different symptoms, different combinations of symptoms, and different congenital malformations, their clinical manifestations are complicated, but these clinical manifestations can be attributed to different causes and incentives. Different neurological dysfunctions occur when the spinal cone is subjected to different times and degrees of traction. Common clinical signs and symptoms are:

Pain

It is the most common symptom. It is manifested as pain or discomfort that is difficult to describe, and can be radiated, but often without the distribution of skin segments. The painful part of a child patient is often difficult to locate or is located in the lumbosacral region and can be radiated to the lower extremities. Adults are widely distributed and can be located in the deep rectum, mid-hip, tail, perineum, lower extremities and lower back, either unilaterally or bilaterally. The nature of the pain is mostly diffuse pain, radiation pain and electric shock, and there is little pain. Pain is often exacerbated by sedentary and forward flexion of the body, rarely aggravated by coughing, sneezing, and twisting. The straight leg elevation test is positive and may be confused with the pain of disc herniation. Suffering from lumbosacral tears can cause severe discharge-like pain with short-term lower limb weakness.

2. Movement disorders

Mainly due to progressive weakness and difficulty walking, can involve unilateral or bilateral, but the latter are more common. Sometimes the patient complained of unilateral involvement, but the examination revealed changes on both sides. The lower extremities can have both upper and lower motor neuron damage manifestations, namely, disuse muscle atrophy with increased muscle tone and hyperreflexia. In the early stage of children, there are no or only lower extremity dyskinesia, symptoms appear with age, and progressive aggravation, can be expressed as lower limb length and thickness asymmetry, valgus deformity, skin atrophic ulcer.

3. Sensory disorder

Mainly in the saddle area, the skin feels numb or the feeling is diminished.

4. Bladder and rectal dysfunction

Bladder and rectal dysfunction often occur simultaneously. The former includes enuresis, frequent urination, urgency, urinary incontinence and urinary retention, the latter including constipation or fecal incontinence. Children with enuresis or urinary incontinence are most common. According to the bladder function test, it can be divided into a small bladder and a low-tension bladder. The former often combined with gait, urinary frequency, urgency, stress urinary incontinence and constipation, the performance of motoneuron damage; the latter showed low-flow urinary incontinence, increased residual urine volume and fecal incontinence, etc. The performance of motor neurons damaged.

5. Abdominal skin abnormalities

90% of children with subcutaneous masses, 50% have skin sinus, meningocele, hemangioma and hirsutism. About 1/3 of the children had subcutaneous lipomas on the lateral side and the other side had meningocele. The subcutaneous mass of the lumbosacral region can be very large, which is caused by the attention of parents due to aesthetic problems. Individual sick children can have skin lice and form a tail. The above skin changes are less than half in adults.

6. Promote and aggravate factors

1 Child's growth and development; 2 Adults are seen in activities that suddenly pull the spinal cord, such as upward kicking, bending forward, childbirth, exercise or traffic accident, the hip is forced to flex forward; 3 spinal stenosis; 4 trauma Such as the back injury or fall on the hips when landing.

Differential diagnosis

Need to identify with lumbar disc herniation, lumbar muscle strain, myalgia, spinal cord tumors. Adults also need to be differentiated from spinal stenosis. CT and MRI scans can help to confirm the diagnosis.

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