Distribution and imaging characteristics of spina bifida occulta in young people with low back pain: a retrospective cross-sectional study

Purpose Spina bifida occulta (SBO) is one of the most common congenital spinal deformities. Although many studies have demonstrated the influence of lumbosacral dysplasia on low back pain (LBP) in young athletes, there have been few studies on SBO among young people in other occupations. The purpose of this study is to investigate the distribution of SBO in young people with LBP and to classify SBO from the perspective of lamina development. Methods The X-ray films of 148 young patients with LBP were analyzed to quantify the distribution of SBO and classify abnormal laminae. Results Of the 148 patients, 93 (61.49%) had SBO: 83 cases involved S1 alone, 2 involved L5–S1, 5 involved S1–2, 2 involved S1–4, and 1 involved L4–S4. According to the degree of the defect, the patients with SBO were divided on the basis of five grades: 9 patients with grade I, 53 with grade II, 23 with grade III, and 8 with grade IV. The cases were classified by the shape of the laminae into 4 types: 15 cases of type a, 11 cases of type b, 37 cases of type c, and 30 cases of type d. Conclusion Among the young people with LBP that we surveyed, SBO is the most common lumbosacral dysplasia, which frequently involves the S1 segment. Most laminae in SBO are in the developmental stage of the spinous process, and an abnormal laminar growth direction and laminar stenosis are the most common laminar morphologies in SBO.

Klippel-Feil syndrome with multiple skeletal anomalies, Dandy-Walker spectrum, and occipital cephalocele—a rare presentation

Background Klippel-Feil syndrome (KFS) is a congenital malformation causing fusion of at least two cervical vertebrae and characterized clinically by presence of triad of short neck, limited neck movements, and low posterior hair line. Various skeletal and non-skeletal anomalies may be seen in association with KFS. Case presentation We present a case of 6-year-old boy of KFS with various skeletal anomalies such as multiple segmentation and formation anomalies of the spine including anomalies of craniovertebral junction (CVJ), spina bifida occulta, scoliosis, Sprengel deformity of right shoulder, and multiple rib anomalies, as well as neurological anomalies like Dandy-Walker spectrum and atretic occipital cephalocele. Conclusion To the best of our knowledge, association of such extensive skeletal anomalies and Dandy-Walker spectrum with KFS has been uncommonly reported in the literature. This case highlights the importance of knowledge of various common and uncommon associations of KFS to avoid missing significant anomalies.

Distribution and imaging characteristics of spina bifida occulta in young people with low back pain

Purpose Spina bifida occulta (SBO) is one of the most common congenital spinal deformities. Although many studies have demonstrated the influence of lumbosacral dysplasia on low back pain (LBP) in young athletes, there have been few studies on SBO among young people in other occupations. The purpose of this study was to investigate the distribution of SBO in young people with LBP and to classify SBO from the perspective of lamina development. Methods The X-ray films of 148 young patients with LBP were analyzed to quantify the distribution of SBO and classify abnormal laminae. Results Of the 148 patients, 93 (61.49%) had SBO: 83 cases involved S1 alone, 1 involved L5, 2 involved L5-S1, 5 involved S1-2, 1 involved S1-4 and 1 involved L4-S4. According to the degree of the defect, the patients with SBO were divided on the basis of five grades: 9 patients with grade I, 53 with grade II, 23 with grade III, and 8 with grade IV. The cases were classified by the shape of the laminae into 4 types: 15 cases of type a, 11 cases of type b, 37 cases of type c and 30 cases of type d. Conclusion Among the young people with LBP that we surveyed, SBO is the most common lumbosacral dysplasia, which frequently involves the S1 segment. Most laminae in SBO are in the developmental stage of the spinous process, and an abnormal laminar growth direction and laminar stenosis are the most common laminar morphologies in SBO.

Anesthetic management of cesarean section of a wheelchair bound parturient with myelomeningocele

Neural tube defects (NTD) affect 1-2 in 1000 pregnancies over the world. The most frequent spinal dysraphisms are meningocele and myelomeningocele while the spina bifida occulta, tethered cord, lipomyelomeningocele, split cord malformations, neuroenteric cyst, and several other conditions occur less frequently. Open spinal dysraphisms (meningocele and myelomeningocele) are compatible with postnatal survival, but they can result in severe neurologic impairment as inability to ambulate, urinary incontinence, hydrocephalus, scoliosis, and gastrointestinal (GI) disorders. Closed spinal dysraphisms (spina bifida occulta, tethered cord, lipomyelomeningocele, split cord malformations, neuroenteric cyst) are often less severe and sometimes asymptomatic but may result in severe neurologic impairment secondary to spinal cord tethering. Modern health care facilities has resulted in a significant decrease in the mortality rate in patients with SB2 along with improved survival rate up to 80%. Due to the neurologic complexity and severity of these conditions, it is paramount to understand the challenges and offer the best anesthetic approach for these patients. To the best of our knowledge, this is the first case of SB going under caesarean delivery in our hospital. We wish to highlight our experience of perioperative management of this patient. Key words: Spina bifida, anesthetic management Citation: Lal S, Aisa T, Akram U, Sher A, Memon Z, Moriarty RM. Anesthetic management of cesarean section of a wheelchair bound parturient with myelomeningocele. Anaesth. pain intensive care 2020;24(5): Received: 13 June 2020, Reviewed: 24 June 2020, Revised: 18 July 2020, Accepted: 8 August 2020

Effects of parental level of income and visual presentation of spina bifida occulta in decision making process

Background: Parents are active participants in the referral process of children with non-life-threatening surgical pathologies. Nonetheless, there is scarce literature about the influence of parent’s level of income and perception of their children’s conditions on their decision process. Our study aims at expanding our knowledge about this parameter. We focused our research on parents of children spina bifida occulta (SBO), a condition that with a broad clinical impact and that often requires timely referral. Methods: Questionnaires in Mandarin were administered to parents of patients presenting to the neurosurgery clinic of a children’s hospital in Shanghai. Participants were grouped according to the level of income, above and below 50,000 Yuan. The SBO was classified into two groups, with and without evident subcutaneous mass. Results: One hundred and forty-five participants completed the questionnaire. Regardless of the type of lesion, families with lower income attributed their concerns for seeking care to their local physicians and the lack of health resources. Families with higher income exhibited fear of treatment. The lower income cohort presented for treatment at an older age than a higher income group. Patients with subcutaneous mass presented for treatment at a younger age than those that did not exhibit mass. Conclusion: Parental social economic background and visual presentation of SBO have to be factored when analyzing their decision-making process when seeking care for their children. Parental factors can be barriers to surgical care. Healthcare providers must bring parents to the forefront of the treatment process.