Legacy: "Atlast of Neurosurgery" / L.Karaguiosov, A. Ramadan, K.Karaguiosov / Kiwait/ 1998
PREV>14. Operations on Intervertebral Discs
NEXT< 16. Arteriovenous Malformations of the Spinal Cord
15. MALFORMATIONS OF THE SPINE AND SPINAL CORD
There is a wide variety of congenital pathologic conditions of the spine and spinal cord, of which the most frequent of them are open neural tube defects (meningocele, myelomeningocele, myeloschisis, tethered spinal cord, split-cord malformations, syringomyelia, dermal sinus with or without tumour. The common denominator of this variety of condition is a congenital defect in the posterior elements of one or more vertebral segments. In myelomeningocele there is a characteristic dorsal protrusion of more or less severely malformed spinal cord elements and their coverings between the bifid bony structure on the surface of the back.
Neurological deficits in the lower extremities are often severe, with an associated loss of bladder and bowel control. These deficits are present at birth and usually do not alter. The Chiari malformation and progressive hydrocephalus are common.
The group of malformations leading to a tethered cord have fewer external manifestations, but sometimes produce progressive neurological deficits.
Syringomyelia has a special place among congenital malformations. It is caused by an enlarging central canal (hydromyelia) at paramedian location with accumulation of fluid within the spinal cord. This malformation is frequently related to the Chiari malformation.
The surgical treatment in general cannot eradicate the malformation, but in many cases, it can stop the progression of the neurological deficit, prevent infection and in some cases it may bring about improvement of a recently developed neurological deficit. In many cases, the operation has a cosmetic purpose.