Spinal hernia in children and adults: causes, diagnosis and treatment. Congenital spinal hernia in children: what is the danger of the disease Spinal hernia in the fetus what to do

In this article, we will consider ways to treat a herniated disc in a child and we will tell you in detail about the cases in which it is shown surgery to remove a herniated disc lumbar.
Intervertebral hernia in children, which is also called a herniated disc - a disease of the spine, from the category of degenerative-dystrophic pathologies. After injury to the spine, due to stretch marks and rupture of the annulus fibrosus, the disk with the share of the nucleus pulposus is forced to move to a place not intended for it. Intervertebral hernia is one of the rather dangerous pathologies of the spine and treatment with conservative methods is not always effective.

Vertebral discs in children flexible enough. In most cases, too large spinous processes of the vertebrae in the lumbar region interfere with straightening, and poorly developed (short) ligaments hinder bending. If the child's posture deteriorates, the back is loaded unevenly. Then, due to various circumstances and the negative influence of the environment, damage appears on the discs, the lower back hurts, which contributes to the appearance of an intervertebral hernia of the lumbar. The child feels squeezed and sometimes cannot perform simple movements. Pathologies of the spine can be congenital, or occur after an injury.

With osteochondrosis, intervertebral hernia- one of the frequent and unpleasant symptoms in children. There is a possibility of developing a pain radicular syndrome, in which paresis occurs, sometimes paralysis of the legs, the sensitivity and functioning of the pelvic organs worsens, the perineum becomes numb.

Every fifth patient with lumbar disc herniation lies down on the operating table. Indications for surgery: uncontrolled pain syndrome, progressive neurological deficit, affected cauda equina syndrome. Next, you need to be treated under the supervision of doctors for 2-12 weeks (depending on the neglect of the disease, and on how the patient underwent surgery).

If health problems appear, all organs begin to work hard to restore their previous state and recovery. For a person with a herniated disc, it is enough not to break bed rest and not be nervous for 9-13 weeks for everything to heal by itself.

At the present time, it is gaining more and more popularity method of treatment like traction of the spine. It is especially effective in the acute stage. With traction, the pressure between the vertebrae is unstable, which makes it possible to restore the shifted disc.

Therapeutic gymnastics is most often used for both treatment and prevention of intervertebral hernia. Exercise improves muscle function and the immune system. You need to do it constantly, but so that the child does not feel pain, everything is done easily. At the acute stage, physical activity is not recommended, only during the recovery period.

Below, we will elaborate on the reasons why intervertebral hernia in a child What is the most effective treatment for the disease? You will learn what a lumbar disc herniation is in children and adolescents and whether it is possible to do without spinal surgery by observing only precautions in everyday life and doing strengthening exercises.

Next article.

Spinal hernia is one of the most dangerous congenital conditions found in newborns. It begins to manifest itself due to a violation of the development of the fetus. Approximately at the same stage, this pathology is detected.

Etiology and mechanisms of development of pathology

Spinal hernia is most often found in newborns, as well as during fetal development. According to the ICD, this disease was given the code Q05.

This type of pathology is characterized by non-closure of the neural tube and incomplete formation of the spinal cord. As a result, in the affected area there is a splitting of the spine, that is, its arcs do not close tightly.

The result of this condition is the protrusion of the spinal cord outward with the formation of a hernial sac. Pathology of this kind occurs in 1-2 cases out of a thousand births. The disease is called Spina Bifida. In this case, depending on the variety, the severity of the disease will differ from case to case.

Causes

If we talk about the causes of development, then doctors have not yet come to a consensus. The most likely factors that affect the development of the fetus:

• Infections that the mother suffered during pregnancy;
• genetic predisposition;
• Adolescence of the mother;
• Malnutrition, deficiency of vitamins and minerals (folic acid is especially important);
• Medication consumption, ;
• Exposure to chemicals during pregnancy.

The closure of the tube is considered normal at about 7-8 weeks of gestation. and it is at this time that the above factors have the maximum impact on the fetus.

Causes of the development of spinal hernia

Types

If we talk about types, then hidden and hernial forms stand out. hidden is considered the easiest in the context of symptomatology. But hernial, in turn, can significantly complicate the life of a newborn up to complete disability.

Hidden

Hidden refers not to the protrusion of the spinal cord outside the spinal canal, but rather the presence of a gap in the spine.

According to the symptoms, it manifests itself most easily, although it also requires treatment.

hernial

Herniated Spina Bifida can be of several types depending on the tissues affected.

With this type of pathology, a hernial sac is formed, which protrudes beyond the spinal column. if we talk about the severity of the course of this type of disease, then it will differ in each case.

The following types of pathology are distinguished according to the degree of manifestation and severity of the course:

• Latent splitting is the mildest form of the disease. It just creates a gap.
• Meningocele is more symptomatic than the previous type, since in this case a hernial sac is already forming. But in this state, the spinal cord and nerve roots are not displaced, but the meninges are affected. Symptoms from the nervous system are usually not present, and outwardly this condition is manifested by a tubercle in the affected area.
• Myelomeningocele is a rather severe form in which the spinal cord bulges outward with the surrounding membranes. The nerve roots are partially included in the hernial protrusion. The result is an irregular shape of the medulla and a curved shape of the spinal cord. Most often manifested by motor disorders.
• Myelocystocele is a rather severe type of disease in which the structures of the spinal cord are disturbed. It manifests itself as a violation of the functionality of internal organs. At the same time, brain fluid accumulates in the affected area.
• The most severe form is Rachischisis. This type is incurable. The membranes of the spinal cord, soft tissues, and vertebrae are completely affected. In this case, the brain is on the surface, remaining unprotected. This condition in 100% of cases ends in the death of the newborn.

Depending on the type of pathology, even during pregnancy, doctors work out treatment tactics that begin either during gestation or immediately after birth.

Varieties of spinal hernias

Symptoms

Symptoms will depend on the degree of damage to the structures of the spinal cord. The latent form is often asymptomatic. But other varieties can appear:

• protrusion in the affected area;
• Hyperpigmentation, excessive hair growth in the area of ​​the hernia;
• Lack of sensitivity in areas that are below the protrusion;
• or ;
• Partial emptying of the bladder or;
• (cerebral edema).

The latter, of course, is considered the most dangerous manifestation that can affect the health and life of a child in the future. Therefore, without fail, doctors conduct a diagnosis, which includes a blood test for alpha protein (also called germ protein).

A blood test for alpha protein is performed around the 15-20th week of pregnancy. prenatal and amniocentesis are also mandatory. The latter is a puncture of the fetal bladder. It is done only if there is a suspicion of such an anomaly of development.

Treatment Methods

The problem is that pathology is most effectively treated even during intrauterine development.

But in Russia, only a few surgeons can perform such operations, and no one can vouch for the consequences of such an intervention.

The most effective therapy and surgery are carried out abroad.

Conservative

If we talk about conservative methods of treatment, then they are considered effective only if an operation was performed to eliminate the spinal hernia. That is, it is rather an additional measure of influence, which is aimed at improving the quality of life, preventing further deformation of the skeleton, and maintaining mobility. Usually applied:

• Wearing and;
• and gymnastics;
• Prevention of bedsores;

Drug treatment is assumed only if there are appropriate symptoms, for example, intensive. Otherwise, it is considered useless. It is also important that a sufficient amount of necessary substances, elements, vitamins enter the patient's body.

Surgery

Surgical treatment is usually mandatory, especially in the presence of a hernial protrusion. With the latent form, doctors can still decide whether this kind of therapy is required.

If a hernia is present, treatment is planned before the baby is born. Of the surgical intervention can be carried out:

• Perinatal surgery, in which the anatomical defect is eliminated while the fetus is in the uterus, is performed at 20-25 weeks of pregnancy;
• After childbirth, an operation of the same type is performed on about 3 days;
• In the presence of hydrocephalus, shunting is performed to eliminate the accumulation of fluid;
• Elimination of orthopedic anomalies - joint dysplasia, bone deformities, and so on.

It is important to understand that such types of intervention do not guarantee the elimination of disorders of the nervous system, and therefore various dysfunctions of the internal organs may remain, which should be treated separately. Surgical intervention can only prevent the further development of pathology and life-threatening conditions. When performing a perinatal operation, doctors recommend further planning a caesarean section, otherwise the risk of spinal cord injury increases many times over.

Important! According to statistics, it is perinatal intervention that is the best choice, since it does not give a large number of side effects, and after birth, the vast majority of children lead a normal life.

What is dangerous congenital spinal hernia

Congenital spinal hernia has its complications. As mentioned earlier, with the development of Rachischisis, a fatal outcome always occurs. In other cases, the following consequences may be observed:

• Complete or partial paralysis;
• Hydrocephalus with subsequent impairment of physical and mental development;
• Violation of the nervous system;
• Violation of the work of internal organs;
• Asymmetry or incorrect position of the legs from an anatomical point of view.

Some conditions can significantly affect the life of a child and lead sooner or later to disability and death.

Forecast

It is believed that it is unrealistic to completely cure a child from such a disease. But the hidden form lends itself most easily to correction. In other cases, much will depend on the experience of the surgeon.

In any case, doctors say that the relief of the condition, the creation of full-fledged conditions for life with the help of surgery is possible in 100% of cases. Further, already during conservative therapy, it is possible to correct the ODA in order to minimize the manifestations of the disease in adults.

About the methods of treatment of spinal hernia in our video:

10. Malformations of the central nervous system. Spinal hernias in children. Classification. Clinic. Diagnostics. Complications. Medical and surgical tactics.

spinal hernia

Spinal hernia is a severe malformation characterized by congenital non-closure of the posterior wall of the spinal canal with simultaneous hernial protrusion of the dura mater, covered with skin and containing cerebrospinal fluid or the spinal cord and / or its roots. The complex of anatomical and functional disorders that occur with a spinal hernia is conditionally united by the term "myelodysplasia".

Myelodysplasia is a collective concept that unites a large group of spinal cord malformations with typical localization (caudal regression syndrome) and a wide range of manifestations, from rachischisis to hidden, purely tissue changes. Myelodysplasia is divided into two forms: organ (spinal hernia) and tissue (bone markers of the latter include non-fusion of the vertebral arches, agenesis of the sacrum and coccyx, diastematomyelia, etc.). Indirect signs of the tissue form of myelodysplasia: areas of skin pigmentation or depigmentation in the lumbosacral region, foci of intense hair growth, dermal sinus in the upper part of the intergluteal fold.

The frequency of birth of children with spinal hernia is 1 case per 1000-3000 newborns. Malformation at the level of the cervical spine is found in 3.2% of cases, thoracic - in 18%, lumbosacral - in 56%. About 40% is the radicular form ( meningoradiculocele ).

Quite often, this pathology is combined with other congenital anomalies: hydrocephalus, diastematomyelia, Arnold-Kiyari and Klippel-Feil syndromes, craniostenosis, cleft lip, cardiopathy, malformations of the lower urinary tract, anus atresia.

With congenital malformations of the lumbosacral spine (spinal hernia, agenesis of the sacrum and coccyx, various types of dysplasia of the lumbosacral articulation, diastematomyelia, etc.) against the background of various neurological manifestations (urinary and fecal incontinence, decreased tone of the pelvic floor muscles, lower flaccid paralysis and paresis, trophic ulcers of the perineum and lower extremities) often meet variants of regional tissue dysmorphism in the form of hemangiomas, lipomas, lipofibromas and lymphangiomas (“spinal dysraphism syndrome”).

The basis of the occurrence of a spinal hernia is a malformation of the spinal cord, which appears as a result of a delay in the laying and closing of the medullary plate into the brain tube. The process of development and closure of the vertebral arches is disrupted, which normally, together with the soft tissues formed from the ectoderm and the membranes of the brain that originated from the mesoderm, closes the spinal canal. As a result of the presence of a bone defect in the posterior wall of the spinal canal, under the influence of increased CSF pressure in the subarachnoid space, the spinal cord with roots and membranes protrudes, forming a volume formation, partially or completely covered with skin.

The etiology of this malformation is not well understood. A large number of physical, chemical and biological factors, acting on the body of the fetus during the formation of the spine, can cause this congenital malformation. Variants of caudal dysembryogenesis are shown in Figs. 3-19.

Classification

Depending on the degree of underdevelopment and the participation of individual elements of the spinal cord and spine in the pathological process, several anatomical forms are distinguished (Fig. 3-20).

meningocele

With this form of defect, non-fusion of the vertebral arches is detected. Only the membranes of the spinal cord protrude through the defect. The contents of the hernial sac are cerebrospinal fluid without elements of nervous tissue. The spinal cord is usually not changed and is located

right. In the neurological status, various variants of dysfunction of the pelvic organs are possible, phenomena in the distal th paraparesis, paretic deformities of the feet.

Meningoradiculocele

The composition of the hernia includes the roots of the spinal cord, some of which are fused with the inner wall of the hernial sac. With this form of malformation, additional intramedullary formations are often observed in the form of lipomas (lipomeningocele), congenital arachnoid cysts, etc. The spinal cord has the usual anatomical location. The severity of neurological symptoms depends on the level of the lesion. The higher the localization of the spinal defect, the more pronounced the neurological “fallouts” from the pelvic organs and lower extremities.

meningomyelocele

With this form, in addition to the membranes and roots of the spinal cord, the spinal cord is directly involved in the hernial contents. Usually, the spinal cord, leaving the spinal canal, passes into the hernial sac and ends in its center in the form of a germinal plate not closed into a tube. The gray and white matter of this part of the spinal cord is formed incorrectly. With this form of malformation, neurological defects are significantly pronounced: in children, total urinary and fecal incontinence, flaccid or spastic paraparesis, and paretic deformity of the lower extremities are usually detected.

Myelocystocele

Myelocystocele is the most severe form of hernia. With it, the spinal cord suffers especially strongly, protruding along with the membranes through a defect in the spine. The thinned spinal cord is stretched by the cerebrospinal fluid accumulating in the viciously enlarged Central Canal, often the brain is adjacent to the inner wall of the hernial sac or fused with it. This form is characterized by yellow neurological disorders with impaired function pelvis out organs and paresis of the lower extremities. Myelocystocele mo can be located in the cervical, thoracic and thoracolumbar departments

spine. The most severe and irreversible neurological loss is recorded in this form of malformation.

Rakhishizis

With this pathology, there is a complete splitting of the soft tissues, spine, membranes and spinal cord. The spinal cord, not closed into a tube, lies in the form of a velvety mass of red color, consists of dilated vessels and elements of brain tissue. Posterior rachischisis is often combined with anterior (when not only the arches, but also the vertebral bodies are split) and severe deformities of the brain and other organs. Most often, rachischisis is found in the lumbar region. Children with this form of malformation are not viable.

Spina bifida occulta

Spina bifida occulta - hidden defect of the vertebral arches, when there is no hernial protrusion. The most common localization of this form is the sacral and lumbar spine. At the level of non-fusion of the vertebral arches, various pathological formations can be observed in the form of dense fibrous cords, cartilage and adipose tissue, lipomas, fibromas, etc. X-rays reveal non-fusion of the arches, and sometimes the vertebral bodies. Spina bifida complicated by a tumor (eg, lipoma, fibroma) is known as spina bifida complicata . Lipomatous tissue is located under the skin, fills the defect in the vertebral arches and can not only grow together with the membranes of the spinal cord, but also penetrate into the subarachnoid space, where it often grows intimately with the roots and spinal cord located below the usual level (intraradicular growth).

Diastematomyelia

Diastematomyelia is an anomaly of the spine, characterized by the presence of a bone spike (in some patients, inversion of the spinous process), which compresses and divides the spinal cord into two halves. Usually, the anomaly has many additional dysraphic signs in the form of skin hyperpigmentation and hypertrichosis over the affected area, a short terminal filament, scoliosis, etc.

Along the midline of the spine, usually in the lumbardepartment, determine the tumor (sizes vary), often covered with thinned in the center and scar-changed skin. With a sharp thinning

skin tumor translucent. At its base, there is a study

runoff of excessive hairiness or vascular spot. at the base

tumors palpate nonunited vertebral arches (Fig. 3-21).

Disorders of sensitivity in congenital malformations of the spinal

of the brain are made up of segmental, conductive and root

out violations. They can be manifested by anesthesia, hypesthesia, less often - hyperesthesia. There are the following neurological options -

cal prolapse: anesthesia of the perineum and lower extremities, the absence of bulbocavernosus, anal, Achilles, knee, plantar and cremaster reflexes, which indicates a combined anterior and posterior horn type of lesion, as well as the prevalence of the myelodysplastic process. Severe trophic disorders in the form of trophic ulcers of the perineum and lower

extremities occur in a third of patients.

Characteristically, the lag in the development of one of the lower limbs (or both), which is expressed in its shortening, a decrease in the size of the foot, muscle atrophy, excessive sweating or dryness of the skin, cyanosis, pallor, changes in skin temperature. Moreover, with bilateral pathology, these symptoms are expressed differently on the right and left.

Pelvic disorders join the already existing neurological motor and sensory disorders. However, it should be borne in mind that dysfunction of the pelvic organs (chronic constipation or weakness of the rectal closure apparatus with fecal incontinence, total urinary incontinence, lack of urge to urinate) may appear long before the development of severe neurological symptoms.

Hydrocephalus occurs in 30% of patients with spinal hernias. Timely neurosonography of the brain makes it possible to clearly verify the diagnosis and, in the presence of increasing intracranial hypertension, to perform ventriculo-peritoneal shunting of the brain ventricles and thus stop the growth of hydrocephalic-hypertensive syndrome (Fig. 3-22).

Urinary incontinence is the leading symptom in the clinic of myelodysplasia, occurring in 90% of cases. The manifestations of this symptom are varied and occur in the form of pollakiuria (with a frequency of urination up to 40-60 times a day), imperative urinary incontinence (the urge to urinate is usually absent or manifests itself in the form of a pain equivalent), enuresis.

The neurogenic bladder in myelodysplasia has its own characteristics. They are associated with at least two circumstances. The first is the localization of the defect and its relation to the complex system of innervation of the bladder. Underdevelopment of the spinal cord at the level of Lj-S 3 segments, where the centers of urination are predominantly located, determines the possible variants of cystic dysfunctions. Secondly, a child is born with impaired innervation of the bladder, so the natural stage of the formation of a reflex to urinate falls out.

Bladder motor dysfunctions are exacerbated by secondary progressive disorders of the detrusor blood supply, vnutripu- cystic hypertension and chronic inflammation. To moment appeals the patient to the doctor in the urinary system is sometimes created extremely unfavorable ny situation, manifested by total leukocyturia, bacteriuria, bo lyami in the abdomen, intoxication, urinary incontinence, etc. Concerning not- it is necessary to use a large and diverse complex of clinical, radiological, urodynamic and electrophysiological research methods.

A serious problem in the treatment of patients with myelodysplasia is an uninhibited (unadapted, unstable) bladder, a form of dysregulation of the act of urination that is characteristic of this disease. The bladder should be called unstable if between two acts of urination, i.e. in the accumulation phase, the detrusor causes an increase in intravesical pressure when exposed to any stimuli. According to one point of view, the sacral parasympathetic center of the bladder is in a hyperactive state and receives inhibitory influences from the overlying parts of the spinal cord. With a delay in the development of the supraspinal centers or malformations of the spinal conductors, the hyperactive state of the spinal center causes chaotic uninhibited contractions of the detrusor during the filling phase, i.e. leads to the development of an uninhibited bladder.

Uninhibited activity of the bladder and disturbances in urodynamics by the type of intermittent hypertension are due to a sharp excitation of all elements of the efferent link of the parasympathetic nervous system, including the sacral center, pelvic nerves, M-cholinergic receptors, which is confirmed by the effectiveness of the blockade or the intersection of the sacral roots (risidiotomy). The correct interpretation of this fact is of great importance for the choice of an adequate tactics of surgical treatment.

The lag in the development of supraspinal centers in the presence of congenital pathology of the caudal parts of the spinal cord leads to a lack of subordination of the external urethral sphincter to volitional control. Normally, reflex relaxation of the detrusor is accompanied by reflex spasm of the sphincters, and with detrusor-sphincter dyssynergy, involuntary contraction of the detrusor is accompanied by contraction of the sphincters. Such urethral obstruction causes an acute increase in intravesical pressure, exceeding the voiding pressure. Clinically, this condition is manifested by pollakiuria, imperative urges (with the preservation of the reflex arc), urinary incontinence, non-localized pain, etc. An x-ray examination of such patients often reveals vesicoureteral refluxes, up to the megaureter.

Fecal incontinence is one of the main clinical signs of myelodysplasia; it is observed in 70% of patients. True fecal incontinence in such children practically does not occur due to the phenomena of chronic coprostasis, and incontinence is in the form of constant stool smearing.

Pronounced denervation changes in the lower extremities in the form of flaccid paraparesis, paretic clubfoot are noted in 60% of patients. Moreover, the degree and prevalence of paresis can vary; it is expressed the less, the more caudally the defect of the spinal canal is located.

In severe cases, spinal hernia is accompanied by lower paraparesis and dysfunction of the pelvic organs. The child is constantly wet, as feces and urine are continuously excreted.

but causing maceration of the skin. The tone of the external anal sphincter is absent, the anus often gapes. The lower limbs are bent at the hip joints and located at right angles to the body. All these symptoms indicate deep disorders of innervation and severe underdevelopment of the spinal cord.

Diagnostics

In recent years, intrauterine prenatal diagnosis using ultrasound has become widespread. When severe forms of spinal hernia are detected, as well as other severe malformations of the skull, spine, brain and spinal cord, termination of pregnancy is indicated.

All variants of spinal hernia can be combined with malformations of the brain or spinal cord at a different level, so such patients should perform x-rays of the entire spine. Along with this, ultrasound, CT and MRI should be performed to detect diastematomyelia, syringomyelia, volumetric formations such as lipomas, fibromas, teratomas, cerebrospinal fluid cysts, the presence of a dermal sinus, which in principle changes the tactics of treatment (Fig. 3-23, 3-24, 3-25 and 3-26).

Differential diagnosis is carried out mainly with teratomas of the sacrococcygeal region, which are characterized by a lobular structure, the presence of dense inclusions and an asymmetric location of the tumor. An x-ray examination helps to make the correct diagnosis, which reveals non-fusion of the vertebral arches in spinal hernia.

Treatment

The only correct and radical method of therapy is surgical treatment. It is indicated immediately after diagnosis. With small hernias with good skin, if there are no dysfunctions of the pelvic organs and lower extremities, the decision on the operation should be approached very carefully, since as a result of traumatization of the elements of the spinal cord intimately soldered to the hernial sac, neurological disorders of the iatrogenic nature may develop after the operation.

spine

essencesurgery is to remove the hernialbag and plas tic defect of the vertebral arches. During the neonatal period, the indications for surgical intervention for meningoradiculoiele are rupture of the hernia membranes and the possibility of infection with the development of meningitis. If there is no such immediate threat, surgical treatment should be postponed to a later date (1-1.5 years) and should be carried out in a specialized hospital using precision microsurgical techniques. If the child was operated on at an early age and he has persistent neurological disorders that are resistant to ongoing conservative treatment, a thorough comprehensive examination is necessary to resolve the issue of a possible reconstruction of the conduction apparatus of the spinal cord.

The study of the results of surgical treatment of anomalies of the spinal cord indicates that the restoration of its temporarily lost functions occurs in some patients after the elimination of spinal cord compression, i.e. after elimination of exposure to such constant irritants as bone osteophytes, arachnoid adhesions and cysts, epidural scars, lipomas, lipofibromas, etc. Based on this, compression of the spinal cord (i.e., the presence of a focus of pathological irritative impulses), a number of sick with congenital anomalies of the spine and spinal cord, it is necessary to eliminate it surgically. The correctness of this fundamental position is confirmed by the immediate and long-term results of surgical treatment.

The basis of surgical treatment of meningoradiculoiele ( or the consequences of a previous hernia removal) and other benign diseases of the caudal spine and spinal cord are the following principles.

Elimination of the focus of efferent pathological impulses.

Restoration of the anatomical and topographic relationships of the elements of the cauda equina and an attempt to reinnervate the underlying segments.

Improvement of hemodynamics in the affected area and restoration of normal CSF flow.

A similar effect can be achieved by microsurgical radiculolysis with precision excision of all cicatricial adhesions, cerebrospinal fluid cysts and other pathological intraradicular formations.

The complexity of surgical tactics lies in the fact that with the elimination of spinal hernia, surgical treatment in most children does not end. Only a complex multi-stage treatment with the involvement of specialists of various profiles gives the desired effect: a urologist (treatment of combined anomalies of the urinary system and dysfunctions of the bladder), a neurosurgeon and a microsurgeon (with developing hydrocephalus and for reinnervation of the pelvic organs), an orthopedist (for restoring the supporting function of the limbs) .

When determining the range of therapeutic measures, one has to take into account literally all the links of the homeostasis of the body of a child suffering from myelodysplasia, because only such an approach can provide a certain level of clinical effect and social adaptation of the child.

11. Necrotizing enterocolitis of newborns. Etiology. Classification. Clinical manifestations and diagnosis of perforation of the gastrointestinal tract. Providing emergency surgical care (laparocentesis, laparotomy). Complications. postoperative treatment.

Definition. Ulcerative necrotic enterocolitis (YANEK) intrauterine prolonged pathological state of the intestine caused by hypoxic-ischemic damage, persisting in the postnatal period with the development of a local ischemic-reperfusion process, necrosis, and with the formation of ulcers.

• Stage		Symptoms		Gastrointestinal symptoms		X-ray logical signs		Treatment
  IA - suspected YANEC		Changes in body temperature, apnea, bradycardia, lethargy		Delayed gastric emptying, mild bloating, vomiting		Normal or moderate paresis		Cessation of enteral nutrition, antibiotics 3 days
  IB - suspected YANEK				Bright red blood from the rectum
  IA-set- { lenny I YaNEK, easy form				The same + lack of intestinal peristalsis, +/ _ pain on palpation of the abdomen		Expansion of intestinal loops, paresis of the gastrointestinal tract, intestinal pneumatosis		Termination of enteral nutrition, antibiotics 7-10 days, if the tests are normal 24-48 hours
  IIB - established by YaNEK, moderate form		The same + metabolic acidosis, thrombocytopenia		The same + lack of intestinal peristalsis, severe pain on palpation, signs of phlegmon of the anterior abdominal wall		The same + gas in the portal vein +/- ascites		Termination of enteral nutrition, antibiotics for 14 days, NaHCO, with acidosis
  IIIA - heavy YNEK, without perforation		The same + arterial hypotension, bradycardia, severe apnea, respiratory and metabolic acidosis, disseminated intravascular coagulation syndrome, neutropia		The same + peritonitis, severe pain and tension of the anterior abdominal wall		The same + pronounced ascites		Cessation of enteral nutrition, antibiotics for 14 days, NaHC0 3 with acidosis + 200 ml/kg per day fluids, inotropic agents, ventilation therapy, paracentesis
  III in -	Same as		Same as IIIA		Same as		ditto + ope
  heavy					IIIB + pneumatic		walkie-talkie
  YANEK, with					moperitoneum
  perforation
  ki
  shechnik

• Epidemiology. The frequency of necrotizing ulcerative enterocolitis is 4-28% of all newborns hospitalized in intensive care units. In the United States of America (USA), about 4 million children from 1200 to 9600 newborns are born every year with ulcerative necrotizing enterocolitis. The lowest prevalence of NEC is in Japan and the Scandinavian countries, where it is 10-20 times lower than in the USA.

  Risk factors YANEC.

Antenatal risk factors:

chronic fetoplacental insufficiency;

chronic intrauterine fetal hypoxia;

intrauterine growth retardation.

Postnatal risk factors:

body weight at birth below 1500 g;

gestational age below 32 weeks;

enteral feeding with milk mixtures;

the need for artificial ventilation of the lungs;

respiratory distress syndrome.

The probability of the risk of developing a disease in the interaction of factors such as chronic intrauterine hypoxia, gestational age less than 32 weeks and enteral feeding with milk mixtures is 12.3 times higher than in newborns who were not exposed to these risk factors.

Pathogenesis.

Fetoplacental insufficiency and chronic fetal hypoxia are accompanied by an increase in vascular resistance of blood flow in the uteroplacental and fetal-placental circulatory systems, which indicates

about vasoconstriction and reduced blood supply to the visceral

organs, including the intestines. The combination of prolonged intrauterine fetal hypoxia and reduced intestinal

th blood flow causes hypoxic-ischemic damage to the intestine even before birth. This circumstance can cause morphofunctional immaturity of the intestine after birth.

Enteral formula feeding leads to phase changes in the hemodynamics of the ileum: vaso-

constriction in the first 20 minutes and vasodilation after 30 minutes

barely feeding. Vasoconstriction followed by vasodilation

in the ileum, similar to pathophysiological mechano-

nisms of non-occlusive ischemic and reperfusion effects

damage in the intestines with the release of free radicals

oxygen, pro-inflammatory cytokines, with a significant increase

disruption of NO production, which plays an important role in the physiological

gie intestines. Damage to the intestinal mucosa in

ischemic and reperfusion states is also due to the formation of eicosanoids, neutrophils, an increase in the level of plasma and intestinal platelet activating factors that can increase the permeability of the intestinal mucosa. The change in the permeability of the intestinal mucosa in combination with its hypoperfusion facilitates bacterial translocation, the interaction of microorganisms with the mucosal epithelium, which leads to local inflammation with the release of pro-inflammatory mediators.

The combination of antenatal and postnatal disorders of the intestinal circulation, their interaction with the metabolic needs of enteral feeding, the ability to cause ischemic and reperfusion injuries of the ileum have a pathological effect on tissue oxygenation and, in combination with the morphofunctional immaturity of the intestine, lead to the occurrence YANEK(tab. 21.1).

YaNEK classification (Walsh M. C. et.al.. 1986)

Stage I includes neonates with suspected disease. These children have mild systemic and gastrointestinal disorders. X-ray examination reveals moderate dilatation of intestinal loops, but most patients have normal radiographic findings. Malnutrition, refusal to eat, especially in newborns with low body weight, are noted.

In Stage II The diagnosis of JNEC is confirmed by the presence of intestinal pneumatosis on x-ray examination of the abdomen. Moderate pain on palpation of the anterior abdominal wall in stage IIA becomes more pronounced in stage I B. The condition of the children worsens, signs of metabolic acidosis appear, and thrombocytopenia in laboratory blood tests. The appearance of edema of the anterior abdominal wall, strengthening of the subcutaneous venous network in the umbilical region and along the umbilical vein indicate developing peritonitis.

More severe or progressive disease is classified as stage III, which is characterized by clinical instability with progressive deterioration in the function of vital organs, respiratory failure, disseminated intravascular coagulation (DIC) and shock. In stage IIIA, the intestine is intact, while in stage IIIB, intestinal perforation is observed.

Diagnostics. X-ray examination is an integral part of a comprehensive examination of a newborn with NEC.

Bowel distension and edema of its wall manifests itself as multiple gas-filled overstretched bowel loops with fluid levels.

Intestinal pneumatosis is defined as a pathological process characterized by swelling of the intestinal wall due to the formation of gas bubbles in it.

The presence of gas in the portal vein - the accumulation of gas in the direction of the portal vein in the form of linear formations, which spreads from the intestine through the mesenteric veins.

Pneumoperitoneum - free gas in the abdominal cavity indicates intestinal perforation.

Fixed and dilated intestinal loops in any part of the abdominal cavity on a series of radiographs for 24-36 hours are a sign of developing intestinal necrosis.

Treatment.

Conservative treatment. If there is a suspicion of NEC or at the initial stages of its manifestation, the treatment regimen can be presented in the following form:

cancellation of enteral feeding;

decompression of the gastrointestinal tract;

Infusion therapy and parenteral nutrition;

Rational antibiotic therapy;

selective decontamination of the intestine;

Immunostimulating therapy;

desensitizing therapy.

Surgery. Indications for surgery:

clinical deterioration of the child's condition determines -

with instability of vital functions and maybe about

be systemic arterial hypotension, oliguria. lethargy and adynamia, respiratory arrest, growing metabolic acidosis. Availability of listed symptoms, despite intensive therapy, is an indication for hee surgical treatment;

hyperemia and edema anterior abdominal wall, strong constantly pain on palpation of the abdomen are signs peritonitis and an absolute indication for surgical treatment;

pneumoperitoneum- classical criterion, defining indications for laparotomy or laparocentesis;

radiological sign of the presence of gas in the portal venous system has a high specificity and predictive value of a positive result for intestinal necrosis;

reduced intestinal gas filling and the presence of fluid in the abdominal cavity are considered as signs of latent perforation of the intestine and developing peritonitis;

motionless dilated bowel loops, determining on a series of X-ray examinations during days, only 57% of patients serve indication for surgery. Clinically stable patients with the indicated feature you get well with intensive care;

positive laparocentesis result assessed by the presence of free inflammatory fluid in the abdominal polo sti and serves as evidence of necrosis of the intestine. The diagnostic sensitivity of the test was the highest (87%) compared to the previously listed criteria;

laboratory blood tests, including assessment the number of leukocytes, platelets, determination of the ratio of the number of young neutrophilic granulocytes to the total to the number of segmented leukocytes, have a fairly high diagnostic sensitivity (64%) and spec feature (100%) and, therefore, can determine Bye* knowledge for surgical treatment. The diagnostic value of the listed criteria increases when they are combinations. Tests are considered positive when the number of leukocytes is less than 9000 mm 3, platelets are less than 200,000 mm 3, with indicator ratio of metamyelocytes to total segmented nucleus more than 5 leukocytes.

A spinal hernia in children is a congenital anomaly due to which one or more vertebrae do not close in the area of ​​the spinous processes during their development, resulting in a gap into which the spinal cord itself and its membranes fall out. This problem is most common in the lower spine, although in some cases it can occur in other regions. In this case, the severity of the disease is determined by the size of the area of ​​\u200b\u200bnerve tissues that were left without appropriate protection.

Such a hernia in the fetus is determined by the results of an ultrasound scan, so intrauterine diagnosis of this disease is quite possible.

Why does a spinal hernia appear in babies?

So far, no one can name the exact cause of the development of this disease, but it is generally accepted that the most important factor in this case is vitamin deficiency.

In addition, this disease is congenital, but not genetic. There is an opinion that if a woman gave birth to a child with such a defect, then there is a possibility of such an anomaly occurring in other pregnancies. But in practice, in cases where a woman began to take care of getting all the necessary vitamins and minerals for the development of a child, the appearance of such a defect is practically impossible. Thus, a congenital hernia may well be a "one-time" problem, and it will not occur in the next pregnancy.

What are the types of spina bifida?

Two main types can be distinguished - hernial and hidden splitting.

Latent cleavage is the most common situation and is considered a mild form of the disease. In this case, the shape of only one of the vertebrae is usually slightly disturbed. Most people with this type of disease do not have any problems and do not notice any symptoms of the disease, except for a small depression located above the affected area of ​​​​the spine.

Hernial splitting is considered a severe form of the disease, since with it vertebral defects are much more serious. The most noticeable sign of the presence of this disease is a hernial protrusion, which contains the membranes and the spinal cord itself, as well as cerebrospinal fluid. But at the same time, quite often the nerve roots remain intact and function normally. The situation is much more complicated when not only the spinal cord and its membranes, but also nerve roots and trunks are located in the hernial protrusion. In this case, the child is often born with a number of severe sensory and motor disorders.

What are the symptoms of such a disease?

As we have already said, with a latent type of disease, there are practically no symptoms. Hernial splitting declares itself quite seriously, with it it can be observed:

• leg defects and incorrect position of the legs;
• complete or partial paralysis of the legs with loss of sensation;
• almost always a hernia and hydrocephalus appear simultaneously. Moreover, if such a disease is not treated, then in its advanced form it leads to the appearance of serious disorders in the brain;
• almost always there are problems with the bladder up to its paralysis, which leads to urinary incontinence, the rapid spread of infections and the destruction of the kidneys themselves. Often, the anus and rectum are also paralyzed.

Is this disease treatable?

Unfortunately, this disease is practically untreatable. This is exactly the case when you need to take care in advance that it does not appear, since it is almost impossible to cure it completely.

In the general case, a patient with such a disease is constantly under the supervision of the attending physician, which is especially important for children who have hydrocephalus associated with spinal hernia. To get rid of problems with the bladder, hygienic methods of keeping and a number of urological procedures are used. To eliminate chronic constipation caused by problems in the work of the rectum, a special diet is prescribed, which involves a large amount of coarse vegetable fiber.

Partly, some physiotherapy procedures help restore mobility, so that a sick child can become completely independent. Otherwise, you will need a wheelchair.

It is better not to joke with such a diagnosis as a herniated disc, since the spinal cord passes through the spinal canal, from which the nerves that provide innervation to organs and systems depart. Naturally, when squeezing nerve endings, not only symptoms of pain can appear, but also disturbances in the work of certain organs. According to statistics, it is the lumbar region that is often affected, since it accounts for not only physical activity, but also the need to withstand body weight. The lower back is often prone to trauma during sudden movements, due to muscle strain when lifting weights, and, as you know, anesthetize the condition when the lumbar region does not hurt so easily. Consider the causes and signs of a herniated lumbar spine, as well as the principles of treatment, including pain relief, physiotherapy, advice on how to sleep and how to sit properly. Let's analyze what a hernia is in terms of anatomy and physiology.

The lumbar spine consists of 5 large vertebrae, interconnected by intervertebral discs, which, in turn, create a cushioning function. Also, discs are needed to evenly distribute the load across the lumbar. The reliability of the disk is provided by the fibrous ring, and inside this ring is a core, of a semi-liquid consistency. With an increase in loads, after injury to the back or from other circumstances, destruction of the fibrous ring is possible, that is, the appearance of cracks through which the core partially enters the spinal canal - protrudes. So, over time, a hernia of the intervertebral discs is formed, which, in turn, can compress the nerve endings, blood vessels, narrow the lumen of the spinal canal, which leads to negative consequences. The patient may be at risk of disability with a hernia that disrupts the functions of the genitourinary system, the gastrointestinal tract, causing paralysis of the lower extremities, so we will consider the causes and risk factors in order to protect ourselves from this pathology.

Causes

An intervertebral hernia is one of the rare pathologies that can result from both an overly active lifestyle and a sedentary lifestyle. Most often, a person is faced with the fact that he has signs of a hernia of the cervical spine and lumbar zone. A hernia of the spine in the lumbar region can be caused by constant stress on the muscular apparatus, that is, people suffer whose work is associated with lifting weights, working with vibrations. The second risk group is athletes, and weightlifters are especially susceptible. If at a young age intensive training keeps the muscular apparatus in good shape, then with the cessation of training, chronic injuries begin to appear, damage to the musculoskeletal corset in the lumbar region.

In women, childbirth is often the cause of the appearance of a hernia, and it may not be the birth itself that is to blame, but the weight gain during pregnancy, and after it, carrying the child in her arms. There are problematic births, when the fetus is large or has an incorrect presentation, then the risk of spinal injury increases.

Risk factors for the development of a hernia in the spine:

• getting a back injury, especially in an accident, when the body body experiences a concussion or a jerk;
• a blow to the back with a blunt object or a fall from a height onto the back;
• impaired metabolism due to alcohol abuse, junk food, diabetes, smoking;
• lack of vitamins and minerals, the condition with aging of the body is especially pronounced;
• obesity, which increases the load on the lower back.

Most often, these reasons are combined, for example, people with diabetes are prone to obesity and a sedentary lifestyle. It is worth noting that a hernia of the lumbar spine is not noticed immediately, since the disease is characterized by progression, a slow onset of the development of the pathological process. A degenerative-dystrophic process is observed in the spine, accompanied by malnutrition of the discs, which is why it loses its strength. That is why the disease can also be caused by various infections, such as tuberculosis, syphilis, which affect the body systemically.

And of course, do not forget about the factor predisposing to hernia - osteochondrosis. Most patients with a hernia have a history of this disease, since osteochondrosis affects the structure and nutrition of the spine.

Symptoms

Most often, a hernia in the lower back develops between the L4-L5 vertebrae, a little less often the sacral region is also involved in the process, that is, in L5-S1, which makes it possible to conclude that the lower lumbar region suffers and this is due to increased loads on this area.

Consequently, the symptoms often involve in the process not only the lumbar region, but also the buttocks, lower limbs, which is why the disease is characterized by such complications as lumbago, infringement in the sciatic nerve, radiculopathy and others. Therefore, it is better for patients with a hernia not to joke with their health so as not to start the disease, since complications of a hernia lead to the fact that the patient often cannot not only run or swim, but also walk normally.

Pathology is characterized by symptoms of pain, the strength of which increases with exercise. If compression of the nerve endings occurs, then backaches appear - a sharp pain with every movement, which disappears at rest. Anesthesia for lumbago with conventional drugs (analgesics, NSAIDs) is not always helpful, therefore, as a rule, patients seek medical help. In addition to pain, a person with such a diagnosis suffers from stiffness in the lower back, sensitivity is disturbed, a burning sensation and tingling appear at the site of hernia formation.

When inflammation develops associated with compression of the spinal cord or nerve endings, additional symptoms appear. In addition to the fact that the pain increases sharply from turning or tilting the body, so the sensations of pain spread to the buttocks, go down the legs, up to the toes. The patient may have problems with the genitourinary system, manifested in a decrease in potency, retention, or, conversely, uncontrolled urination. The digestive tract can suffer. If the hernia is not treated, then the patient is threatened by the occurrence of paresis and paralysis.

Conservative treatment

With the help of conservative treatment, it is unlikely that a hernia will be completely cured, in many respects it all depends on the size of the hernia, but if you start treatment in the early stages, you can stop its growth, that is, stop progression. At the same time, if you strengthen the muscle corset, you can avoid squeezing the nerve endings, which is why doctors often resort to non-surgical treatment.

Therapy has two directions at once, the first of which is aimed at eliminating the symptoms of pain. For this, the following methods are used:

• drug therapy - drugs of the NSAID group (Ibuprofen, Diclofenac, Meloxicam), muscle relaxants (Sirdalur, Mydocalm);
• non-traditional methods - acupuncture (acupuncture), by the way, acupuncture is only allowed to be performed by a doctor;
• blockade of the spine with hormones - Diprospan, Kenalog in combination with Lidocaine.

A blockade for a hernia of the lumbar spine is prescribed when other methods of anesthesia are ineffective, since with the introduction of hormones there is a threat of side effects. A hernia blockade is performed every 3 months, in advanced cases more often. To reduce the symptoms of pain, acupuncture is used for hernia.

The second direction of treatment is aimed at strengthening the muscles, for which it is necessary to train in order to pump up the muscles. But do not forget that the training program should be selected individually. A popular technique is hyperextension for a hernia of the lumbar spine, that is, special exercises aimed at strengthening the muscles of the lower back. For this, special simulators for hernia are used.

A lumbar brace, which must be worn according to the doctor's indications, helps to reduce the load on the spine. Some doctors advise using an exercise bike for exercise. By the way, it is not recommended to pump the press with a hernia in the usual position from the floor, so you should not perform those exercise therapy exercises that the doctor did not prescribe.

Swimming is effective for hernia, which is why swimming is also recommended for prevention, especially for people with spinal curvature. A swimming pool can replace sea water, and if you go to the pool with osteochondrosis, then the chance of developing a hernia decreases. If a woman is expecting childbirth, then she is also recommended to visit the pool, but you need to work with a trainer and after consulting a gynecologist, then the birth will be successful.

By the way, about the issues of prevention. You can bring a technique that helps to strengthen, pump up all muscle groups and protect the spine from osteochondrosis, hernia - this is a fitball. Fitball is an excellent prevention of diseases of the musculoskeletal system, which consists in exercising with a special elastic ball.

Do not forget about nutrition with a hernia of the spine. It is necessary to exclude alcohol, cigarettes, fatty and fried foods. It is recommended to add vitamins to your diet.

Often, to relieve inflammation, physiotherapy is indicated for a hernia of the lumbar. The question arises - is it possible to apply all the FZT techniques, the answer to it is no. A doctor can choose the procedures, since electrical stimulation has a number of contraindications. Well helps electrophoresis with a hernia of the lumbar spine.

Prevention of complications

Now he will talk about what is possible and impossible in case of a disease, that is, contraindications for a hernia of the lumbar spine. A diet for hernia is necessarily observed, walking helps, as a sedentary lifestyle negatively affects the disease.

Massage is allowed, going to the pool, that is, swimming is not only possible, but also necessary. Of the exercise therapy exercises, weight lifting is prohibited, that is, strength exercises, techniques that can greatly stretch muscles and ligaments. Squats are shown only in the early stages. By the way, squats, pumping up the press help with a preventive purpose, and as you know, prevention is better than cure.

You can not independently prescribe painkillers for a hernia, lift weights, sit in a chair for a long time. Many are concerned about the question of how to live with such a diagnosis, and so with early treatment and following the recommendations, you can even prevent disability.

Of course, in advanced cases, an operation is necessary and a long rehabilitation period is required, which includes a pool, FZT, exercise therapy.

2017-01-19

Achondroplasia (photo) is a congenital disease that is associated with a violation of the growth and development of bones. Most often, pathology affects the skull and skeleton. Features of the disease - low human stature (maximum 130 cm).

Why does the disease appear

What is achondroplasia? Parro-Marie syndrome (another name for the disease) develops due to a mutation in the FGFR3 gene. Less commonly, the pathology is inherited. Sometimes the fetus dies.

The main reasons for the development of achondroplasia are violations of bone formation, which are the result of dystrophy of the epiphyseal cartilage.

This leads to slower bone growth. The skull and tubular bones are usually affected. One of the reasons for the occurrence of pathology is the relatively late age of the parents. If the father is over 40 years old, then the chances of developing the mutation increase.

Characteristic features

Symptoms of the disease can be recognized immediately after the birth of the child. Such children have a rather large disproportionate head, short legs and arms. Sometimes there is hydrocephalus.

Parro-Marie syndrome is noted in the form of violations of the structures of the facial skeleton, which occur due to abnormal development of the bones. Patients with this disease have wide-set eyes that are located deep in the orbits. Additional folds form near the inner corners of the visual organs.

Signs of pathology can be recognized by the characteristic nose. It has a saddle-shaped flattened shape with a wide top. The patient's tongue is rough and the palate is high. The arms and legs of patients with achondroplasia are uniformly shortened. Differ in patients and feet - they are wide and short.

Infants with this disease often die in their sleep. This is due to compression of the medulla oblongata and spinal cord. 1-2 years of a child's life is accompanied by the formation of cervicothoracic kyphosis, which disappears after the baby begins to move actively.

Children with achondroplasia develop slowly. They can hold their heads 3-4 months after birth, babies learn to sit when they are one year old. Such children can move only from 2 years. The intelligence of patients is at the same level as that of healthy people.

Adults with Parrot-Marie disease can be recognized by the growth deficit that occurs when the legs are shortened. Women with this pathology reach 124 cm in height, and men grow up to 131 cm. In some patients, deformities of the head and nose remain noticeable. Often there is strabismus. Adults with achondroplasia are often overweight. They may develop conductive hearing loss and otitis media.

Carrying out diagnostics

It is not difficult to determine the diagnosis of pathology, since Parro-Marie disease is noticeable by characteristic changes in appearance. Patients must first be carefully examined to determine the level of deviation from normal skeletal formation and development. All data are entered into a table, which is compiled specifically for such a disease, and compared with the indications.

If a newborn needs an analysis for achondroplasia, then first the baby should be examined by a neurosurgeon. You can also see the changes on ultrasound. Doctors recommend an MRI and CT scan of the brain. To study the condition of the nasal passages and ENT organs, the patient is examined by an otolaryngologist. Sometimes a consultation with a pulmonologist is additionally required. For the diagnosis of pathology, radiography is used:

• skulls;
• chest;
• pelvis
• spine;
• tubular bones.

If a child has Parro-Marie disease, then he is observed by a doctor from the moment of birth until the end of his life.

Therapy Methods

The genetics of the disease is such that the pathology cannot be completely eliminated. At a young age, conservative treatment is used, which helps to strengthen the muscles and stop the deformity of the limbs. It is better for patients with achondroplasia to wear only orthopedic shoes, they are prescribed a complex of exercise therapy and massage. Obesity prevention is often recommended. For this, patients are prescribed a special menu and exclude dishes that lead to excess weight.

Treatment of achondroplasia with surgical intervention is justified only if the patient has severe deformities of the limbs and narrowing of the spinal canal is noted. To eliminate such symptoms, a laminectomy is prescribed. Sometimes surgeries are performed to increase height. The limbs are stretched in 2 stages. Initially, the thigh is lengthened on one side and the lower leg on the other, and then similar actions are carried out on the remaining parts of the body.

Other operations are often carried out:

1. Fusion of vertebrae. Manipulations are carried out to connect individual vertebrae to each other. The intervention helps to cope with kyphosis of the back.
2. Osteotomy. An incision is made in the leg bone, through which the individual parts of the vertebrae are connected. The procedure is used in severe form of modification of the knee joint. Also practiced for patients who have crooked legs.

Achondroplasia is sometimes treated with the use of a special growth hormone. But the drug affects each person differently.

Life expectancy with Parro-Marie disease depends on the patient's individual health indicators and compliance with all medical recommendations.

is a rare but severe developmental anomaly. This defect of the spinal cord manifests itself in only 0.1-0.03% of newborns, and approximately two-thirds of them remain disabled for life.

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

Causes of 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). Recognized by most researchers as the main cause of the disease;

Pregnancy at an early age;

Heredity.

The neural tube of the unborn child is formed in the first eight weeks of pregnancy. It is at this time that the impact of the above factors can provoke insufficient fusion of the posterior wall of the spinal canal. Because of this, one or more vertebrae are separated 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 come out.

Forms of spinal hernia in newborns

Doctors divide different cases of spinal hernias according to their localization and structural features. The location of the defect plays a big role for the patient and the doctor treating him, since the severity of the symptoms and the complexity of treating the pathology depend on it.

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 slight deformity of one of the vertebrae is diagnosed, which often does not bring inconvenience to the patient. In some cases, mild neurological symptoms appear, but without significant health effects.

A more serious defect in the structure of the spine provokes hernial splitting. At the same time, a protrusion that extends beyond the skin integument is clearly visible. 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 herniated spinal cord can belong to one of three types of localization:

In the cervical region - the rarest variant of a hernia. It affects the upper part of the 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 impaired, which affects the motor activity of both the upper and lower extremities, as well as the heart and lungs;

In the chest- 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 heart, as well as internal organs (stomach, spleen, liver, duodenum) are at risk;

In the lumbosacral region- the most common anomaly affecting the lower limbs, bladder and rectum, sometimes even the kidneys and genitals.

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

According to it, 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 membrane. The spinal cord itself remains properly formed and capable;

meningomyelocele- in addition to the shell, 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 beyond the body, although the neural tube remains in its place;

Myelocystocele is the most severe form of anomaly, in which the spinal tissues are stretched from the inside by cerebrospinal fluid (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 of the complications occurs, caused by a 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 death occurs before this moment.

Symptoms of spinal hernia

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

In terms of neurological symptoms, about a hernia with a protrusion of only one membrane, the same can be said as about hidden splitting. The only difference is that a hernia is a volumetric formation, not a deepening. In some cases, this place is also marked by redness, shine or bluish coloration of thinned skin, as well as dark hairline.

Neurological symptoms are manifested 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.

They belong to:

Lack of tactile and (or) pain sensitivity;

Paresis, paralysis and malnutrition of the lower and, in rare cases, upper limbs;

Dysfunction of the pelvic organs, in particular, the muscles of the bladder, anus and genitals.

Violation of the coordination of the work of the heart, lungs, organs of the digestive and endocrine systems is rare when it comes to a 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, swelling, trophic ulcers on the skin of immobilized limbs;

Flexion contractures (immobility of the joints, which eventually becomes irreversible);

Bedsores in the buttocks and lower back;

Incontinence of feces and urine.

Diagnosis of spinal hernia in newborns

Accurate diagnosis of a spinal hernia requires a complete physical examination, which begins with an anamnesis. In the case of contacting a doctor after childbirth, in which no pathologies were found, special attention is paid to age indicators during the period of manifestation of the symptoms of the disease (weakness in the limbs, signs of atrophy and difficulty in muscle activity).

Mandatory are such diagnostic procedures as:

Examination by a neurologist, during which an assessment of motor activity is carried out, a check of the muscle tone of the limbs, the detection of protrusion and the fixation of relevant medical indicators;

Transillumination is a special light scanning, thanks to which it is possible to detect and characterize the contents of the 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 damage inflicted to the spinal cord during the formation of a hernia;

The study of layered images of magnetic resonance or computed tomography of the spine, clarifying the data on the violation in the spinal cord and making it possible to predict the further development of the pathology;

Consultation with a neurosurgeon to determine the feasibility of surgical intervention.

Treatment of spinal hernia in newborns

The only recognized treatment for spina bifida with 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 cause disturbances in motor activity and sensitivity, as well as while maintaining normal skin), the operation must be postponed. Rushing surgery can result in damage to important spinal structures, causing the same neurological disorders that need to be avoided. Any other vertebral hernia requires urgent mandatory surgery.

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

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

After the removal of the meningocele and all the required rehabilitation procedures, the development of the child continues normally. In most cases, these children grow up capable of leading an active lifestyle.

Repair of meningomyelocele, meningoradiculocele and meningocystocele hernia can cause certain difficulties, both during and after surgery. Proper observance of the requirements of the rehabilitation period helps to avoid violations of the motor activity of the limbs, but the same cannot be expected from the functions of the pelvic organs. Urinary and fecal incontinence can persist much longer than in normal children. In adult life, even with the preservation of external signs of health, infertility is found in women, and erectile dysfunction in men.

Prevention of spina bifida

Since spinal hernia is a congenital anomaly of development, the prevention of this disease is the elimination of its causes even before conception. The primary measure is to provide the unborn child with all the necessary microelements 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 spinal cord herniation, the emphasis is on vitamin B9 (folic acid). Interestingly, this substance can enter the body of the fetus not only from the mother, but also from the future father, since it is transmitted through the seminal fluid, while having a significant effect.

Any future 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. To begin with, most pharmaceuticals are stopped for at least the first eight weeks, while the neural tube forms in the embryo. Also, do not get carried away with cosmetics, the same applies to any household chemicals.

Education: Moscow State University of Medicine and Dentistry (1996). In 2003 he received a diploma from the educational and scientific medical center for the management of the affairs of the President of the Russian Federation.