Spinal dysraphism is a form of neural tube defect with inadequate coalescence of the spinal center line. The etiology of this midline fusion defect is still unknown and the treatment is surgical. However, since there is significantly increased risk of neurologic disturbances of these patients, several disciplines should always be enrolled in management and treatment.
This review is consisted of all information regarding spinal dysraphism in pediatric patients, necessary for all medical specialists enrolled in treating these patients, and the most important basis for understanding development, manifestation, and treatment options for neurologists and neurologic surgeons.
The main trigger for writing this article is the great experience we are constantly acquiring in treating the majority of patients with this anomaly in Serbia. Also, by writing this article, our goal was to indicate similarities and differences in managing these patients between Serbia and the rest of the world.Dr. Srdjan Nikolovski, MD
Spina bifida is one of the most complex and serious birth defects. Former term spina bifida today is suppressed by the terms that better describe the essence of anomalies: neural tube defects (NTDS) or spinal dysraphism. In the basis of this anomaly is inadequate "closing – coalescence of center line" of the spine, so the term spinal dysraphism is the most adequate. Midline fusion defect may occur in different levels of the spinal canal, so there are the cervical, thoracic, lumbar and sacral spinal dysraphism. Spinal dysraphism occurs in two basic entities - open and closed, that are fundamentally different. The incidence of this anomaly in the world shows the geographic and ethnic particularity - is most common in the Celtic people (12.5 per 10,000 live births.), and it is rare in Asians and the Negro population. Girls are more often affected than boys. The etiology is still unknown. Diagnosis open spinal dysraphism must be set prenatally. Treatment of open spina bifida is surgical. In the world there are medical centers where it is applied pre-natal - fetal surgery. After birth, surgery should be performed within the first 48 h with appropriate antibiotic support. Newborn should be fully investigated and put on multidisciplinary treatment (neurosurgeon, neurologist, urologist, orthopedist, physiatrist). Closed spinal dysraphism is very insidious, hidden anomalie, and hence the name of occult spinal dysraphism (OSD). The incidence of this anomaly is unknown, it is known only that it is more common in female children. Etiology is also unknown. OSD diagnosis is practically impossible to set prenatally. Tethered cord syndrome - Syndrome of fixed spinal cord, is a condition in which the spinal cord is attached to a fixed structure such as the dura, vertebra, lipoma, skin. Treatment of occult spinal dysraphsm is surgical.