What are the symptoms of spina bifida occulta

The development of the human spine is a process of ossification. By puberty, it will generally develop well. If it is not completely ossified, cracks will easily form in the lumbar vertebrae or sacral vertebrae. This symptom is called occult spina bifida. People with occult spina bifida often have weak lower limb strength, mild muscle atrophy, numbness of the lower limbs, clubfoot deformity, etc.

Clinical manifestations

1. Mild symptoms

Symptoms at the onset include weakness in the lower limbs, mild muscle atrophy, numbness, enuresis, and sometimes low back pain or leg pain. Most of the time, one lower limb is affected, but there are also cases where both lower limbs suffer from muscle weakness at the same time. Examination revealed symptoms of peripheral neuropathy, namely low limb muscle tone, flaccid mild muscle weakness, and decreased superficial and deep sensation in the lower limbs and perineum.

2. Moderate

The above-mentioned movement and sensory disorders are relatively obvious, and clubfoot deformity is common, sometimes accompanied by low back pain, sciatica or urinary incontinence.

3. Severe illness

The lower limbs show obvious muscle weakness, even paralysis; sensation is also significantly reduced or disappeared, often accompanied by neurotrophic changes, coldness and cyanosis of the distal lower limbs, and nutritional ulcers. Some people often develop nutritional ulcers in the sacrum and coccyx, and there is obvious sensory impairment of the skin in the sacral nerve distribution area.

Over time, the lower limbs will show disuse atrophy, and the Achilles tendon reflex will disappear or contracture will occur. Foot deformities may include calf pain, arched feet, inversion or valgus. Some patients present with complete paraplegia and urinary incontinence, as well as incontinence of both stool and urine. A small number of cases are accompanied by intervertebral disc herniation or lumbar spondylolisthesis, and some patients have upper limb symptoms caused by spinal cord thrombosis.

treat

For patients with tethered cord syndrome caused by spina bifida, surgery is suitable, and it is recommended to give surgical treatment as early as possible. Children are mostly treated with basic anesthesia plus local anesthesia, and some are treated with endotracheal intubation and general anesthesia; adults are treated with enhanced anesthesia plus local anesthesia, or epidural anesthesia. Regardless of whether the lesion is in the cervical, thoracic, or lumbar segment, a supraspinal straight incision is used to facilitate the expansion of the laminectomy above and below the spina bifida lesion segment.

After the operation, the patient should lie in the prone or side-lying position for one week. For those with obvious urinary incontinence, catheterization should be performed to keep the surgical site clean and hygienic. For young children, contamination by urine and feces should be strictly prevented, and antibiotics should be used as appropriate to prevent infection. After the stitches are removed, rehabilitation treatment can be added, such as physical therapy, acupuncture, massage, and limb function exercises, and neurotrophic drugs can be used to promote the early recovery of nerve function.