Paediatric Spine Pathologies

There are a host of pathologies which are commonly seen in paediatric age group. The common spinal pathologies include

Dermal sinus
A congenital dermal sinus is a tract of tissue found along the body’s midline anywhere between the nasal bridge and the tailbone. They are commonly seen in the lower back. The tract may end just below the skin surface or may extend to portions of the spinal cord, skull base or nasal cavity. A spinal dermal sinus may appear as a simple dimple or an open tract close to the midline. These tracts are a potential pathway for infections which can extend to deeper part of the nervous system. The sinuses tracking upto the dura have to be surgically removed.

Split cord malformation
The surgery for spilt cord malformation involves complete repair of the congenital pathology. It involves removal of the thin piece of bone or cartilage that divides the spinal cord.  Removing this piece provides more space for the spinal cord within the spinal column and allows to move freely once again.  Sometimes the dura, the sleeve around the spinal cord, is also split and also needs repaired at the time of surgery.

Tethered cord Syndrome
A condition that may occur as a result of any spinal dysraphism, or as a result of other conditions like tumour or infection. In this condition, the spinal cord is restricted due to the atachment at its base and cannot move freely in the spinal column. The resulting stretch on the spinal cord can cause damage to the spinal cord leading to a host of problems like neurological problems (weakness, sensory loss), urological problems (incontinence), orthopedic problems (scoliosis, foot, ankle or leg deformities) and pain. The spinal column is opened from behind via a laminectomy to reveal the location of the tether. The surgeon then works carefully to release the constriction.

Meningocele / Myelomeningocele
In meningocele and myelomeningocele, the defect that exposes the spinal cord is repaired in the first few days of life. The surgeon protects the spinal cord from further damage by removing the adhesions and defines the various layers and then restores as much normal structure as possible, then closes the membranes and skin over the spinal cord. This operation cannot reverse damage that has already occurred. However, it can prevent further damage and reduces the risk of infection.