tailieunhanh - Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 82

Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 82. Spinal disorders are among the most common medical conditions with significant impact on health related quality of life, use of health care resources and socio-economic costs. Spinal surgery is still one of the fastest growing areas in clinical medicine. | MalformationsoftheSpinalCord Chapter 29 805 Case Study 1 A 9-month-old male child was brought for consultation because of a tail-like structure in the low back since birth. Examination revealed a subtle thinning of the right lower extremity and a caudal appendage pseudotail in the lower lumbosacral region a . Plain radiographs revealed spina bifida at L5. MRI revealed a tethered cord with fatty filum terminale. The pseudotail is a short stump-like structure b . Spinal dysraphism is the most frequent coexisting anomaly in both anatomical variants 50 . Other associated lesions include tethered cord syndrome lipomas teratomas and gliomas. Investigation of children born with human tail appendages should include a thorough neurological examination plain X-ray films of the lumbosacral region and contrast MRI to look for dysraphism and associated lesions. During surgery a fibrous fatty filum terminale was seen extending from the base ofthe appendage through the defect in the bone and dura. The hypertrophied and fat-infiltrated filum ended at the tip ofthe low lying conus c . The filum is coagulated with bipolar coagulation as there is typically a small vein within the filum d . We prefer to remove a segment ofthe affected filum e and submit it to pathological examination for confirmation. After surgery there was no change in the neurological status ofthe patient. and are found in patients with caudal agenesis 32 . They are usually discovered in older children or adults complaining of low back pain urinary incontinence or constipation. Myelocystocele A myelocystocele consists of a cystic dilatation of the lower end of the spinal cord or the cervical region enclosed in a skin covered back mass 5 39 . The spinal cord is low lying and tethered 5 . The subcutaneous fat lines the cyst but does not extend into the sac or the cord. A myelocystocele represents a cystic dilatation ofthe spinal cord in the cervical or lumbar spine 806 Section Spinal Deformities and Malformations The