Spinal hernia in children and adults: causes, diagnosis and treatment. Congenital spina bifida and spinal hernia - features of diagnosis and treatment abolition of enteral feeding

16.12.2015

The majority of young patients with herniated discs have some form of malformation of the vertebrae in the lower spine, according to a study published in the December issue of the journal Neurosurgery, the official publication of the Congress of Neurosurgeons.

The study was conducted by Dr. Zh. Liu and colleagues from the Peking University Hospital (PRC). This work helps to understand why this pathology develops in children and adolescents with lumbar intervertebral hernias, because in young patients, natural age-related tissue wear cannot cause the disease. The results of the study also showed that single disc surgery without spinal fusion - the fusion of adjacent vertebrae - can be effective in treating young patients with low back pain caused by a herniated disc.

The authors revealed differences in the anatomy of the lumbar spine in healthy children and young patients with a herniated disc. To look for malformations that might increase the susceptibility to herniated discs in children and adolescents, the authors analyzed x-rays of 63 patients under the age of 20 with low back pain and herniated discs in the lumbar spine. There were 37 males and 26 females among the subjects. The average age of the participants is 17 years. They all tried different kinds therapeutic treatments that did not help relieve severe back pain. Therefore, patients needed surgery.

Almost all patients in the pictures had at least one malformation of the lumbar spine or sacrum. Malformations were absent only in three cases, the authors noted.

Some patients had an abnormally "high" pelvis, and these patients most commonly had disc herniations between the L4/L5 lumbar vertebrae. In patients with an abnormally "low" pelvis, mainly, a hernia appeared between the L5 and S1 vertebrae - in the lumbosacral region. Patients were also identified who had a "transitional vertebra" between the lumbar and sacral spine. This malformation increased the risk of hernia formation between the L4/L5 or L5/S1 vertebrae, depending on the location of the structural formation.

The researchers assessed how patients responded to surgery for chronic low back pain and a herniated disc in the lumbar spine. Surgical treatment was performed in 36 patients. The operation consisted in removing the damaged area of ​​the disc - discectomy. 27 patients underwent arthrodesis - immobilization, fastening of the affected vertebrae.

In all patients, surgery resulted in a significant reduction in back pain and disability.

Lumbar disc herniation in adults is usually associated with repetitive strain and age-related degeneration. However, these reasons cannot explain the appearance of a hernia in children and adolescents.

Dr. Liu et al note that congenital malformations of the lumbosacral spine are strongly associated with herniated lumbar spine in children and adolescents. These malformations may be associated with abnormalities in the structure or lumbar ligaments, which are short, strong ligaments that connect the lumbar spine to the pelvis. These anomalies lead to a violation of the stability of the lower part of the spine.

The study also shows that pediatric patients with a herniated disc in the lumbar spine can achieve significant improvement after surgical treatment, which consists only in the impact on the affected disc. At the same time, spinal fusion does not bring additional benefits to patients.

The authors noted some important limitations in the study. In particular, they did not assess the presence and level of spinal malformations in the control group among patients without disc herniations.

Spinal hernia in newborns, which is difficult to treat, occurs in 60% of all cases of disorders of the musculoskeletal system. It is impossible to completely cure this disease in infants, but with timely measures taken, it is possible to reduce the number and intensity of complications and help the child lead a relatively normal life.

What is spinal hernia

The disease is often accompanied by clubfoot, hydrocephalus (dropsy), as well as related diseases associated with disorders of the urinary system and digestive tract.

Congenital spinal hernia in the fetus in most cases is formed in the lumbosacral region, less often in thoracic region.

Depending on the clinical manifestations It is customary to distinguish between several types of pathological disorders.

Congenital spinal hernias include:

The diagnosis of "congenital spinal hernia" in almost any case means that parents will have to learn how to care for a sick child. Timely prescribed and well-conducted therapy increases the chances of a relatively normal development of the child.

Why is a baby born with a spinal hernia?

To date, the following causes of congenital hernia of the spinal cord have been identified:

Treatment in newborns is associated with a risk of disability. To date, the best method of therapy is considered to be the prevention of the development of the disease. Preventive measures include the correct daily routine, well-chosen diet, minimizing stress during the entire period of pregnancy.

What is dangerous spinal hernia in an infant

How to determine that a child has a spinal hernia

In the West, great attention is paid to the early detection of a hernia, during the development of the fetus. This makes it possible to carry out a successful operation to remove the bulge and almost completely restore the child's health.

When is a spinal hernia operated on in a newborn?

perinatal surgery

Conducting childbirth with a spinal hernia in the fetus is carried out using caesarean section. Natural childbirth can lead to a relapse of the disease.

As practice has shown, the consequences of perinatal surgery in infants are almost imperceptible. Caring for a child is reduced to maintaining the normal functioning of the intestines and Bladder and constant monitoring by a specialist.

Unfortunately, such operations, as well as surgery for spinal hernias in premature newborns, are performed exclusively in Western and Israeli clinics. Domestic surgery centers are gradually introducing such methods of treatment, but at the moment, only a few specialists are able to successfully carry out this type of operation.

postpartum surgery

Over time, it may be necessary to repeat the operation. The results of treatment are affected by the intensity of growth and severity pathological changes. Life expectancy depends on the type of hernia, as well as the presence of hydrocephalus.

Additional methods of surgical intervention

• Shunting - helps to reduce the pressure of hydrocephalus on the child's brain and remove excess fluid.
• Elimination of anatomical anomalies in the structure of the spine.
• Orthopedic treatment.
• Restoration of the work of the intestines and bladder.

Anesthesia for surgical intervention is prescribed only after determining concomitant pathologies. A hernia can affect the functioning of the kidneys and liver of the newborn. In such cases, the appointment of anesthesia is approached with extreme caution.

Where is surgery for congenital spinal hernia performed?

What rehabilitation is needed after surgery

So, after undergoing treatment in an Israeli clinic, sanatorium treatment with spinal hernias is often prescribed in a boarding house located on the shores of the Dead Sea. This enables the surgeon who performed the operation to monitor the patient's recovery process and make adjustments to rehabilitation methods.

During recovery, the following procedures are performed:

Addresses of sanatoriums and rehabilitation centers can be found on the website of the clinic conducting surgical treatment.

Such diseases of the spine as osteochondrosis, spinal hernia in children and adolescents worsen their quality of life, reduce overall performance and quality of education. If the disease is started, it can even lead to permanent disability. IN childhood the process of formation of intervertebral hernias often occurs acutely after trauma or overload of the spine. There is a rupture of the fibrous rings of the intervertebral discs and the contents of the disc migrate into the spinal canal. Then, at any moment of overloading the spine by a child, the process of hernia formation can be part.

Causes

Incorrect posture, shoes that do not fit in children lead to curvature of the spine, the development of osteochondrosis, scoliosis. In such cases, a hernia of the spine can form even after minor loads on the spine.

The risk that many children and adolescents take when playing sports often leads to spinal injuries. This will certainly affect his condition in the future. At first, the child has stiffness in the back, a pulling feeling of heaviness, frequent causeless irritability,. Most often in children, the lumbar spine suffers.

It should be noted that the causes of spinal hernia in children and adolescents are different. Unfavorable mechanisms and biological factors act on the spine during life. Due to upright posture, daily considerable loads are already placed on the spine. In children, they are further exacerbated by stress at school, improper seating, an innate feature of the structure of the neuromuscular structure of the back, individual features of the blood supply to the disc, regeneration and quality of the nervous tissue. The cause of spinal injuries in children can be a direct impact on it in the form of a bruise, a fall, jumping over the head, lifting weights, severe twisting or bending of the body, as well as birth trauma.

It's dangerous for children!

Excessive loads on the spine are harmful to children, but physical inactivity is much more dangerous for them. The gradual loss of muscle tone leads to damage to the muscles and ligaments of the spine, manifests itself in instability and pathological mobility of the vertebrae. This, in turn, leads to inevitable damage to the intervertebral discs in children.

Of particular danger are long-term monotonous loads for children and adolescents. Systematic excessive loads, including long sitting at the computer, harms the spine. This leads to early adolescent scoliosis, to instability of the cervical region. Frequent complaints in children can be dizziness and headaches in such cases. Also, obesity certainly weakens the child, often leading to the development of pathologies of the spine. Excess weight is always an excessive load, which is especially susceptible to the lumbar spine.

Treatment

The best treatment for spinal hernia in children is physiotherapy(LFK). It is prescribed both during the period of exacerbation and for prevention. intervertebral hernia with scoliosis and osteochondrosis. However, if there is already a hernia, any exercises should be preceded by high-quality conservative treatment. In children, it usually includes massage, manual therapy of the spine, as well as underwater traction with simultaneous treatment with anti-inflammatory drugs. nonsteroidal drugs to relieve pain and swelling. And at the end of the treatment, the doctor selects a set of exercise therapy exercises. The appointment of procedures from a qualified exercise therapy instructor is justified. Children's intervertebral hernia is not the case when group classes are shown. Individual training with a small patient is assigned.

The health of the child largely depends on his habits and adaptive reactions. A bad habit of slouching, incorrect posture entails muscle stiffness. Long lessons, improper sitting at the table lead to scoliotic deformity of the spine. In children, there are foci of premature development of osteochondrosis, scoliosis develops, and in the future, complicated forms of spinal diseases (hernia of the spine, displacement of the vertebrae) occur. Parents, be careful! If your child has a clearly observed violation of posture, he is worried about back pain, he often gets tired and feels heaviness in the spine - immediately contact a specialist.

Among the known congenital anomalies, herniated spinal cord in newborns is the most common and occurs in 65% of cases. This is a combined defect, which is often accompanied by clubfoot, hydrocephalus and other anomalies of intrauterine development of the fetus. With this pathology, one or more vertebrae do not close, which leads to the formation of a gap through which the spinal cord and its membranes prolapse.

Most often, this problem occurs in the lower parts of the spine, where the central channel closes last. But spinal hernia can occur in any other part of the spinal column. Spinal cord herniation belongs to the category of serious diseases, and its severity depends on the size of the area of ​​nerve tissue that is deprived of appropriate protection.

Thanks to modern equipment and new research methods, a tumor in the fetus can be detected during pregnancy with ultrasound scanning.

Causes of congenital hernia of the spinal cord

The etiology of this defect has not yet been studied well enough, so scientists and physicians cannot name specific causes leading to a hernia of the spinal cord. Many chemical, biological and physical factors during the formation of the fetus affect his body. According to experts, a predisposing factor is a deficiency of folic acid in the mother's body.

If during the study a congenital spinal hernia is detected, for medical reasons, the pregnancy is terminated with the consent of the parents. Although the condition is congenital, it is not genetic in nature. If a woman receives the whole complex of necessary vitamins and minerals, then during a second pregnancy she has a chance to give birth to a completely normal child.

It is customary to distinguish two types of splitting:

1. hidden, considered the mildest form, in which there are no symptoms of the disease, but only a slight depression is noted above the affected spine;
2. hernial splitting is a severe form of the disease with an obvious hernial protrusion, including the spinal cord and cerebrospinal fluid. Such a pathology may not involve the nerve roots, then their functions are not violated.

A difficult situation is observed if the formation contains not only the spinal cord with part of its membranes, but also nerve trunks and roots. In this case, doctors state that the child has severe motor disorders, sometimes incompatible with life.

Symptoms that manifest hernia in newborns:

• defects of the lower extremities and their incorrect position;
• in most cases, congenital spinal hernia is accompanied by manifestations of hydrocephalus, which, if left untreated, leads to disruption of the brain;
• often there is partial or complete paralysis of the lower extremities with loss of sensation;
• almost always, the tumor causes problems with urination and defecation, which leads to urinary and fecal incontinence.

Based on symptoms alone, it is impossible to make a diagnosis of spinal hernia in newborns. The defect can be judged even before the birth of the child by the high content of alpha-fetoprotein in the amniotic fluid and mother's blood. After childbirth, the tumor is clearly defined on the back of the newborn by a protruding leather bag. Hidden splitting is detected during x-ray examination, although in most cases this spinal defect is detected already in adulthood.

The most difficult thing is to determine the form of a hernia of the spinal cord, which is of decisive importance in the appointment of surgical treatment. Therefore, along with radiography, CT scan And ultrasound procedure. With the help of these modern techniques, it is possible to change, as well as supplement the ongoing treatment.

When diagnosing, it is necessary to take into account that in children under 10-12 years of age, non-fusion of the vertebral arches is not a pathology, but is considered one of the development options.

Unfortunately, the treatment of this disease is due to certain difficulties. We can say that a hernia of the spine of newborns is exactly that rare case when it is necessary to take everything in advance possible measures to prevent it, since it is impossible to cure the disease completely.

In general practice, patients with this pathology are under constant medical supervision. This is especially important given that spinal hernia is most often accompanied by manifestations of hydrocephalus.

Problems with urination can be avoided by applying various hygienic methods of patient care, as well as with the help of urological procedures. To eliminate chronic constipation, which are the result of disruption of the gastrointestinal tract, such children are usually prescribed a special diet.

The food of patients should contain more coarse fiber of plant origin. Physiotherapeutic treatment helps to restore partial mobility to patients suffering from congenital hernia. Regularly receiving procedures makes it possible for some sick children to do without outside help in everyday life.

But very often a congenital hernia leads to a wheelchair. Therefore, it is important to teach parents how to properly care for a sick child. Specialists at consultations explain to fathers and mothers what symptoms may indicate a change in the patient's condition. This is necessary to prevent the development of various complications.

With good care, children with congenital spinal hernia can lead relatively normal lives and even learn individually. Of course, it all depends on the severity of the disease and the location of the formation.

Surgical treatment methods

The only correct option for this disease is surgical treatment. With minor defects, the operation will give a result if it is done in the first few days of the child's life after the diagnosis is established. It is necessary to be very careful when prescribing a surgical intervention, since during the operation it is possible to injure the elements of the spinal cord soldered to the hernia, which will lead to neurological disorders.

An extensive defect is difficult to correct surgically, although it is possible to save a child's life. But such children suffer from physical and mental retardation.

Surgical treatment consists in removing the tumor sac, followed by plastic surgery of the defect formed in the vertebral arches.

But alone surgical methods medical tactics is not limited. The desired effect can only be given complex treatment consisting of several stages. As a rule, the process is not complete without the involvement of various specialists: a urologist, a neurosurgeon, an orthopedist and a psychoneurologist. After all, the symptoms of the disease most often confirm violations of various organs and systems.

All diagnostic measures and treatment are carried out immediately after the birth of a child in a specialized clinic staffed with specially trained personnel and the necessary equipment.
The main point in choosing treatment tactics are severe symptoms and examination results.

Treatment will be optimal only when the congenital spinal hernia is removed on the basis of a correct assessment of the operability criteria. If children have pronounced symptoms of somatic disorders and with a significant extent of the spinal cord tumor, the operation is not performed. In such a situation symptomatic treatment considered as an alternative therapy for such patients.

Treatment of concomitant developmental anomalies is carried out as soon as possible after the spinal hernia in the child is removed. Children who have symptoms of paresis of the lower extremities need long-term rehabilitation. They are prescribed massage, gymnastics, physiotherapy. Particular attention should be paid to the development of the patient's reflex to defecate and urinate at a certain time of the day. The success of treatment and prognosis largely depend on the form of spinal cord herniation, its location and extent.

Preventive measures

In conclusion, I would like to note that in order to prevent the appearance of a hernia of the spinal cord in newborns, expectant mother Even before conception, it is worth consulting with a geneticist about the planned pregnancy. This is especially advisable if the previous pregnancy was complicated by spina bifida in the child.

You should also balance the diet and make sure that the food has a sufficient content of folic acid. By following these simple recommendations, you will reduce the risk of having a child with such serious birth defects.

In recent years, experts have noted an increase in requests for various diseases spine in children and adolescents. Unfortunately, children are not immune from injuries and injuries, as well as from the development of deformities and injuries of the spine. Intervertebral hernias, caused by severe complications of spinal injuries, are quite common reasons why teenagers turn to a doctor.

Diseases of the spine such as intervertebral hernia disks, displacement of the vertebrae (spondyloarthrosis), scoliosis and even osteochondrosis occurring in children can significantly reduce their overall performance, ability to absorb educational material, attention.

The development of such a common disease in children as scoliosis, which can lead to the development of osteochondrosis with its subsequent complications, can be caused by uncomfortable shoes, poor posture, and injuries of the ligamentous-muscular apparatus. Parents may not immediately suspect a pathology of the spine in their children, since the child is initial stages development of the disease may not respond to soreness and not complain of malaise. Therefore, the disease progresses and it becomes more and more difficult to fight it in the future.

Clinical manifestations and symptoms of intervertebral hernia depend on the level of the lesion. In adolescents, the lumbosacral spine is most often affected. This may be due to early sports with heavy physical exertion (lifting barbells, kettlebells). Such overloads can cause pain syndrome of varying severity - from severity and stiffness to lumbar region to bouts of pain that make movement and even walking difficult. If a child complains of the appearance of a constraining tension, pain in the spine, parents should seek help from a doctor. In recent years, even children and adolescents aged 9-12 often complain of back pain.

There are several types of back pain. In children, most often the pain is local in nature, i.e. limited to the affected area of ​​the spine. As a rule, its character changes depending on the position of the body.

Radicular pain - the second most common type of pain - is a "shooting" pain, aggravated by movement. Can be sharp, cutting, give in lower limb. Sometimes there is a violation of the sensitivity of the skin in the form of hyperesthesia. Pain syndrome enhances any movement in the lumbar region: physical exercise, practicing any kind of sport, as well as long-term static loads. Being in one position for a long time, lying on the stomach also increases the pain syndrome, as this increases the degree of displacement of the vertebrae and intervertebral discs. And in case of spinal pathology (intervertebral hernia, spondylolisthesis, etc.), this increases the compression of nerve endings.

Pathology of the spine can be manifested by other than pain symptoms. These are parasthesias or unpleasant sensations in the form of numbness, tingling in the feet, legs. With a herniated disc in the lumbosacral region, a decrease in muscle tone of the buttocks, thighs, and lower legs may occur. As a result of hypotension, these muscles can later be subject to atrophy. Often painful muscle cramps and spasms, scoliotic deformities of the spinal column.

If the cervical spine is affected, vascular syndrome often develops. In children, intervertebral hernias of the cervical spine are manifested by headaches, dizziness, irritability, etc. This disease immediately affects learning - sleep, memory, and attention disturbances lead to poor academic performance. The child becomes apathetic, he is of little interest, drowsiness is expressed or, conversely, hyperexcitability, the falling asleep phase is disturbed, the development of restlessness, irritability, and obsessive movements syndrome is characteristic. With prolonged disruption of the blood supply to the brain due to hernial disease, the child may be disturbed by dizziness, headaches, impaired vision, hearing, and speech. Pain disturbs in the cervical spine, a limitation of movements develops when turning the head.

With pathology in the thoracic region, pain syndrome, intercostal neuralgia, pain in the chest or in the region of the heart are most often noted. Sometimes such pains are accompanied by herpetic eruptions along the intercostal nerves.

Having found the first signs of damage to the spine in a child, do not postpone a visit to the doctor. Today, with timely access to specialists, intervertebral hernias are treated painlessly and non-surgically.