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Cone of the spinal cord in children decoding. Hidden spinal dysraphism (spina bifida occulta). Treatment of a tethered spinal cord

Tethered spinal cord syndrome is one of the rarest pathologies. Basically, it is not diagnosed until a certain point, and this is usually an MRI examination for a completely different disease. In the medical literature you can find several other names for this pathological condition. These include tension filum terminale syndrome, tethering syndrome, rigid filum terminale syndrome, and several other names. Sometimes the word "tied" is used instead of the word "fixed".

What it is

The peculiarity of the disease is that the spinal cord is literally tied to the spine. And most often this is observed in lumbar region. Normally, it is located in a special canal in the cerebrospinal fluid in the very center of the spine.

This allows him to move without any difficulty, and at the same time protects him from damage. With this pathology, the spinal tissue is connected to the vertebrae so tightly that it is, as it were, part of the bone structure.

Causes

Today, several reasons are known for the development of this rare pathology. These include:

  1. Chiari malformation, in which the spinal cord for some reason gets into the upper part of the spinal canal.
  2. Defects in the structure of the lower half of the spinal cord.
  3. Lumbar injuries with damage to spinal tissue.
  4. The presence of scar tissue on the spine after surgery.
  5. Tumors.
  6. Cysts.

Tethered spinal cord syndrome can be identified in both children and adults. In approximately 2 cases per thousand live newborns, this pathology is defined as congenital. But most often the disease develops as a result of the reasons described above, and these are mainly tumors and cysts.

Symptoms

Symptoms will depend on the section in which the fusion occurred. In addition, the manifestations in children and adults will be different. The main symptoms of this pathology in children include:

  1. Tumors on the lower back.
  2. The appearance of hair in this area.
  3. The appearance of dimples.
  4. Change in skin color.
  5. Pain in the legs or lower back.
  6. Difficulty while walking.
  7. Urinary incontinence at night.
  8. Deformation of legs and feet.
  9. Gait disturbance.
  10. , which is very noticeable.

The first symptoms generally begin to appear when the child turns 4 years old. With age, the condition worsens more and more, and some neurological disorders cannot be corrected either by surgery or drug therapy.

In adults, neurological symptoms are mainly observed, but they are several times more pronounced. This is due to a more pronounced load on the spine as a whole.

Diagnosis and treatment

Diagnosis is based on the use of MRI. All other methods do not provide the necessary information about the pathology.

In the most severe cases, the patient is offered surgery to improve the condition. It is carried out as follows. First, the spine in the lumbar region is opened, after which the pathology itself is eliminated. This is usually done by the doctor separating the spinal cord from the bone structure and other surrounding tissues using complex and surgical techniques. All work is carried out using microscopes.

If a relapse occurs after some time after the operation, then the surgical intervention is performed again. For best result Some vertebrae have to be removed. This helps relieve pain and reduces tension. Basically, this procedure is performed when the patient has had several relapses in a short period of time.

Forecast

The operation can eliminate both the fixation itself and all manifestations associated with pathologies. As a rule, after surgery, pain and neurological symptoms completely disappear. True, if the patient delays the operation for one reason or another, then some symptoms may remain forever and it will not be possible to get rid of them. These include weakness in the legs, numbness, a crawling sensation, and some other manifestations. But such treatment will not help restore lost bladder function.

As for children, the operation can be performed up to 4 times. This is due to the growth of the child and the constant development of the spine and vertebrae. In addition, there is still no reliable information about whether this disease can be cured forever after surgery, and why the disease comes back again.

Tethered spinal cord syndrome- a rather rare pathology and is often not diagnosed until neurological syndromes, pain and MRI tests appear. Other names for this spinal pathology:
  • Tension of the filum terminale syndrome (tethering syndrome)
  • Tethered spinal cord syndrome (TSS),
  • Syndrome of rigid terminal, or terminal, filament.
  • Sometimes in Russian-language literature the term tethering syndrome is also used (from English tethered cord syndrome - “tethered” spinal cord syndrome).

What does tethered spinal cord syndrome mean?

Tethered cord syndrome is a condition in which your spinal cord becomes tethered to your spine. The most common location for this lesion is the lumbar spine.

Typically, your spinal cord "floats" in cerebrospinal fluid in the center of your spine. This allows him to move freely and also protects him from damage.

Causes of a tethered spinal cord

There are several reasons for this deviation:
  • Chiari malformation, when the brain enters the upper part of the spinal canal
  • spina bifida, or structural defects of the lower part of the spinal cord
  • injury or damage to the lower back, resulting in injury to the spinal cord
  • scar tissue after surgery
  • tumors or cysts in and near the spinal cord

Risk factors

Tethered spinal cord syndrome affects both children and adults. About 2 in 1,000 people are born with this condition, but as mentioned above, sometimes the disease develops as a result of scar tissue or the growth of a tumor or cyst in the spinal cord.

Symptoms

The symptoms of tethered spinal cord syndrome can vary greatly. In addition, symptoms in children are often different from those in adults.

Symptoms in children may include:

  • Various disorders, tumors, hair growth, dimples, or skin discoloration on the lower back
  • Pain in the legs or lower back
  • Difficulty walking
  • Bed-wetting
  • Deformities of the legs and feet
In 70% of children, symptoms begin to appear at 4 years of age. Symptoms always worsen with age and growth, and some neurological damage may be permanent.

In adults, these symptoms are similar but may be more severe due to increased stress on the spinal cord over time.

Diagnosis of tethered spinal cord syndrome

If tethered cord syndrome is suspected, magnetic resonance imaging (MRI) of the lower spinal cord is performed.

Treatment Methods for Tethered Spinal Cord Syndrome

If tethered spinal cord syndrome causes only minor symptoms or is asymptomatic, your doctor may recommend observation instead of surgery. However, surgery may be indicated even for minor symptoms, since lost neurological functions cannot be restored even after surgery.

Operation

In severe cases, the only way Relieving symptoms is surgery. It involves opening the lower back to remove the affected area. Neurosurgeons typically separate the spinal cord from its surrounding structures using complex surgical techniques while working under a powerful microscope.
In cases where tethered spinal cord syndrome relapses after initial operation, it can be done again. In addition, surgery is sometimes performed to remove a vertebra from the spine. This shortens the length of the spine and can reduce tension on the spinal cord, as well as relieve pain symptoms. This procedure is usually performed for patients in whom the disease often causes relapse.

What is the prognosis after surgery?

Surgery can relieve spinal cord tethering, relieve neurological symptoms and prevent their worsening, and relieve other symptoms, such as pain, that are not neurological in nature. However, symptoms such as weakness and numbness in the legs that result from nerve damage are often irreversible.

Important! Only here, at the American Institute of Spinal Surgery in Cyprus, innovative work is performed in the field of spinal cord injury. This therapy showed clinically significant results - more than half of the patients noted a significant improvement in neurological symptoms, about another quarter noted a noticeable improvement, the remaining patients stated that there was a slight improvement in their condition.

Relapse of this disease occurs in some cases, it is characterized by the return of old symptoms. In these circumstances, revision surgery may be considered.

Damage to the spinal cord of any nature is serious problem, negatively affecting human health and quality of life. Therefore, we will next talk about what tethered spinal cord syndrome is in children and adults, how the disease manifests itself and how it is treated.

Tethered spinal cord syndrome- a phenomenon in which the mobility of the spinal cord is limited.

Reference. The disease has several other names: tethering syndrome, tension of the filum terminale, rigid filum terminale syndrome.

When the disease develops there is fusion of the spinal cord membranes and bone tissue spine. As a result of this pathological process, the spinal cord is tightly and motionlessly attached to the inner surface of the spinal canal.

As the disease develops, the spinal cord becomes fixed

And instead of the fluid that normally protects the spinal cord from damage during movement, connective or bone tissue is formed.

The consequence of such fixation of the spinal cord is the cessation of development and renewal of nerve cells and the appearance of various dysfunctions of the musculoskeletal system.

Most often, the pathological phenomenon develops in the lumbar segment of the spine, since it is in this segment that the most pronounced natural fixation of the spinal cord is observed.

In medicine, to this day the exact causes of this disease have not been determined.

Reference. The disease has a congenital and acquired form, which depends on the cause of development.

Moreover, in 80% of cases the disease has a congenital form and is diagnosed in childhood (4-5 years). And only in 20% the disease is acquired and is found in adults.

May cause spinal problems

Experts have determined that possible reasons the occurrence of pathological conditions include:

  • pathology intrauterine development;
  • in the spine area;
  • destruction of brain tissue;
  • frequent spinal injuries;
  • cicatricial deformation of the filum terminale;
  • various deviations in the structure of the spine;
  • Chiari malformation;
  • Syringomyelia.

Fixation can also occur due to tissue scarring due to surgery in the spine.

The pathology develops gradually and begins to actively manifest itself as the load on the spine increases. For example, with the congenital nature of the disease in children - during the beginning of walking, and with the acquired form in adults - during active recovery from injury.

Reference. The symptoms of the lesion are different and do not depend on the specific form of the lesion.

All manifestations of tethering syndrome can be divided into several groups:

  1. Skin manifestations- increased hair growth, depressions in the soft tissues in the sacrum and lumbar region, dark spots, discoloration of the skin.
  2. Orthopedic- deformation of the legs, asymmetry of the legs, feet, buttocks, changes in gait, poor posture (kyphosis, lordosis).
  3. Neurological- pain in the legs and lower back, unsteady gait, deterioration of sensitivity lower limbs, decreased reflexes, paresis of one or both legs,
  4. Dysfunction of the pelvic organs- disturbances in the process of urination and defecation, frequent infections.

The disease is characterized by various manifestations

The clinical picture of the disease is the same for both adults and children. However, in adulthood, all symptoms are more pronounced, which is associated with serious stress on the spinal column.

Diagnosis

Any examination begins with a survey and examination of the patient, during which complaints, the nature of the manifestation of symptoms and the functional abilities of the body are clarified.

After this, if this syndrome is suspected, the specialist will prescribe an MRI.

Reference. MRI is the only technique that allows you to most accurately assess the extent of damage and determine the shape and location of the disorders.

MRI is the most informative diagnostic method

The purpose of this diagnostic technique is to determine the condition of the spinal cord, spinal canal and soft tissues, identify hidden forms of spinal defects and clarify direct and indirect signs of the pathological process.

Treatment

The only treatment for this disease is surgery. Only a few patients are seen by a doctor after diagnosis of this disease.

Reference. The purpose of the operation is to free the spinal cord and restore function.

Method of implementation selected based on the nature of the damage to the terminal filament:

  • laminectomy- used for insignificant shortening or thickening of the terminal filament, the absence of deep tissue degeneration. It is a minimally invasive surgical intervention using endoscopic instruments.
  • full operation- carried out in case of serious damage to the threads. During the operation, the spinal canal is opened, parts of the brain are released and the surgical cavities are closed with a special thread, glue or staples.

Surgery is the only treatment option

P Treatment of progressive disease may require repeated surgical interventions (2-4). This is especially true in childhood, since the syndrome often progresses with growth and development.

After the operation, the patient undergoes rehabilitation, the duration of which depends on the complexity of the disease and the type of operation. Generally, the duration of recovery is 3-6 months, and sometimes 1 year.

Prognosis after surgery

In tethered spinal cord syndrome, surgery and consequences are interrelated and depend on the characteristics of the disease and the age of the patient.

In general, the prognosis after surgery for children is favorable. Painful sensations go away, and neurological disorders disappear after the correct rehabilitation course.

If the disease is detected early, the prognosis for recovery is good.

If the disease is characterized by a long course, then damage to the nerve endings is observed. This process is irreversible, so even surgery cannot eliminate some of the symptoms of the disease: numbness, paresis of the limbs, dysfunction of internal organs, in particular the bladder.

Possible complications

IN in this case To possible complications may include relapse of tethering syndrome, as well as various surgical and postoperative complications.

To eliminate the risk of complications, you should go to the hospital to receive timely assistance and scrupulously follow all the instructions of your doctor during rehabilitation.

Conclusion

The human body is very complex, so damage to one element can negatively affect the functioning of many organs and systems. This is especially true for damage to the spinal cord and nerve fibers, which can have irreversible consequences.

The spinal cord is the central organ in nervous system. It consists of special fibers that are located in the spine and nerve cells. The spinal cord is a long cylinder. The spinal cord consists of a gray substance that surrounds a white substance. Spinal cord injury can occur due to many different factors. Such a disease, as well as damage to any other part of the spinal cord, can provoke serious disorders of the motor and autonomic systems.

Symptoms

Syndromes and symptoms can be very different, it depends on what level of development the disease is at, and which of the substances is affected. Gray matter is the nerve cells in the spinal canal, and white matter is the processes of such nerves.

When the spinal cord is damaged, the following symptoms appear:

  • Impairment of motor function of the limbs occurs.
  • Pain appears in the lower back and neck.
  • Skin sensitivity is impaired.
  • Incontinence occurs urethra.
  • The sensitivity of joints and muscles is lost, and atrophy may occur.
  • Skin temperature may increase in some areas.
  • Muscle pain appears.

Spinal cord disease can lead to paralysis and cause serious and irreversible consequences, therefore, when the first symptoms appear, you must consult a specialist doctor. He will conduct a complete and comprehensive examination of the body, determine whether there is damage to the spinal cord and at what level of development it is located, as well as which part is damaged. Then the doctor will prescribe the necessary course of treatment.

Syndromes

Briefly, several syndromes can be distinguished depending on their location. For this purpose, a table is provided that briefly describes spinal cord lesion syndromes:

Location of damage

 Syndrome

Damage to the anterior horns

Paresis occurs, that is, partial paralysis of the body and limbs, pain in the muscles and joints that appears in connection with the affected segments.
Damage to the posterior horns

Skin sensitivity disorder appears.

Side edge area

 Central paresis occurs on the affected side, and pain and temperature sensitivity appears on the opposite side; sometimes the location of the affected area may change.
Posterior border area

On the part of the affected area, joint-muscular sensations are lost, they become much lower than the level of damage, and tendon reflexes decrease.

Half spinal cord lesion

 On the side of the affected area, central paresis occurs and joint-muscular sensations are lost; on the opposite side, pain and temperature sensitivity disappears. Half of the spinal cord is completely damaged.
Complete defeat

Sensitivity is completely lost skin, disorders occur in the pelvic region, cervical tetraparesis, thoracic, or paresis at the lumbar level occurs.

Damage levels

There are several levels of spinal cord damage:

  1. Craniospinal disorder.
  2. Syndrome of lesions of the upper cervical segments.
  3. The cervical region thickens.
  4. Damage to the thoracic region.
  5. Thickening of the lumbar region.
  6. Epiconus spinal cord.
  7. Cone defeat.
  8. Cone and epicone.
  9. Damage to the cauda equina.

The first level is due to the fact that the spinal cord is affected mainly due to the presence of tumors or any injuries. Often this lesion occurs in the spinal cord or inside the posterior foramen. In this case, the following symptoms are typical:

  • Pain occurs in the back of the head or neck area, less often in the spine or limbs.
  • Mixed type tetraparesis appears, mainly in the extremities.
  • A partial sensitivity disorder occurs.
  • Breathing is impaired due to irritation of the respiratory apparatus in the medulla oblongata.
  • Cranial nerves are affected.
  • There is a disruption in the functioning of the pelvic organs, possibly urinary incontinence or, conversely, accumulation of urine in the human body.

When the upper cervical segment is affected, the following symptoms may occur: there may be a complete loss of sensitivity, which is below the affected level; radicular symptoms, possible hiccups; paralysis occurs.

The next level of thickening of the cervical spine is characterized by the fact that lower and upper paraplegia occurs, all types of sensitivity and the urethra are completely disrupted.

When struck thoracic region, paraplegia of a spastic nature may occur, sensitivity that is below the affected level may be impaired, the functioning of the urethra may be disrupted, and various reflexes, for example, autonomic, may be disrupted.

When the lumbar region thickens, lower paraplegia occurs, the sensitivity of the lower extremities decreases, and the functionality of the urinary system is impaired.

Epiconus spinal cord is a transverse injury to the spine, which over time can develop into a more serious disease and compromise the integrity of the spinal cord. bone marrow. With such damage, the following symptoms develop:

  • In men, erection may completely disappear or be disrupted.
  • The functioning of the pelvic organs slows down (due to this, feces or urine retention occurs).
  • Symmetrical paresis appears on the feet.

The defeat of the conus is characterized by the fact that people completely lack the anal reflex, erection, impotence, and the functioning of the urinary system is disrupted.

With conus and epiconus syndrome, the above symptoms, which relate to conus and epiconus syndrome, are combined into a single whole. In addition, the trophism of the buttocks may be impaired.

The last level of development of spinal cord lesions is the cauda equina or “roots”. At this stage, the functioning of the pelvic organs is disrupted, pain appears in the pelvic area, more often with a horizontal position of the body, and the sensitivity of the lower extremities completely disappears.

Movement disorders

When the spinal cord is damaged, in any case, affected people experience impaired motor functions. It can be complete and called “spinal cord paralysis” or partial and called “spinal cord paresis”. In the case where four limbs are damaged, a violation of motor functions is called “tetraplegia” or “tetraparesis”, depending on the degree and level of the damage. If only two limbs are affected, then the movement disorder is called “paralegia” or “paraparesis,” which is also affected by the level and extent of the damage.

The movement disorder is almost always symmetrical - on the right side and the left. But there are some exceptions, for example, when the horse's tail is damaged or puncture wounds were inflicted. Another way to put it is that when the damaged area is a point.

There are several levels, but the most critical is defeat cervical vertebra, because breathing may stop - the diaphragm. Accordingly, this can lead to death. Those damages below this level can only cause disorder respiratory system, in this case, if you notice the disease in time and provide first aid, you can save a person’s life.

Loss of sensation

When the disease affects the spinal cord, loss of sensation in the limbs occurs. If the disease does not affect the spinal cord, but passes externally above it, then the person’s sensitivity gradually decreases and then may disappear completely. At the same time, pain and temperature sensitivity may decrease, sometimes there may be a slight tingling sensation, a feeling of goose bumps, and even numbness in the limbs. The degree and level of sensitivity reduction completely depends on the individual characteristics of the person, the structure of his body and the level of damage to the spinal cord.

Vegetative system

When the spinal cord is damaged, autonomic disorders occur, these include:

  • Increased or decreased skin temperature.
  • Increased sweating.
  • Too dry skin in a certain area.
  • Tissue trophism is disrupted (ulcers form).
  • Fecal retention or diarrhea occurs.
  • Failure of the genitourinary system, that is, incontinence or difficulty emptying the urinary canal.
  • Poor functioning of the intestines and stomach.
  • Useful enzymes are produced with minimal intensity.

These symptoms indicate that the person has a failure of the autonomic system, which means that the spinal cord has been affected or damaged.

Painful sensations

Painful sensations with this disease are an integral part; they are almost always present. They appear in the middle of the back, which means that the spinal region is compressed. If pain is disturbing in the area of ​​the upper extremities, then the cervical nerve has been pinched; pain in the area of ​​the lower extremities is a sign of the development of osteochondrosis, which could appear in connection with an injury or tumor in the lumbar region. In order to better determine what disorders may appear if any of the departments are affected, you should consult a specialist doctor. Using diagnostics, the cause of pain will be determined and then eliminated.

Diagnostics

When the first symptoms appear, you should consult a specialist doctor so that he can conduct a comprehensive examination of the body, identify the cause of the disorder, and the level of its development. Diagnosis of the patient is carried out using various methods, such as:

  • radiography;
  • CT scan;
  • myelography;

Thanks to x-rays, you can see fractures, bruises and other factors that could affect the damage to the spinal cord. All methods make it possible to determine the location and level of development of damage, which can adversely affect the patient’s health.

Treatment methods

When providing medical assistance, the following measures must be taken:

  • Apply a bandage to the patient after injury.
  • If possible, provide the victim with as much fresh air as possible.
  • Provide the patient with as much space as possible, free him from tight clothing or foreign objects.

If there is a suspicion that the injury is in the cervical region, the patient must be placed on a stretcher, a cushion placed under his head, and a cotton collar placed on his neck. Before placing the patient on a board or stretcher, it is necessary to lay some kind of bedding. The main thing is that no folds are formed on it, because the patient may develop bedsores, and quite quickly.

After which, before the arrival of medical workers, you can give the victim an Analgin tablet or some other painkiller. Then wait for the ambulance team to arrive.

Drug treatment method

Medical work is primarily administered to the victim:

  • Glucocorticoid hormones.
  • Diuretic drugs, such as furosemide.
  • Neuroprotectors.

Then specialist doctors conduct a full examination of the human body, identify the cause of the disorder, the level and location of the damage. Based on this, further treatment is carried out in accordance with the individual characteristics of the person and his body structure.

Surgical intervention

This treatment method is used if drug treatment did not have an effective result. If a sick person has a cancerous formation, surgery is mandatory. In the presence of a benign formation or injury, surgical intervention is used only when there is severe pain that cannot be overcome with painkillers medicines. If the spine is unstable, and this threatens a general deterioration in a person’s physical condition, surgery is also performed.

Caring for injured people

Caring for victims requires special care. It is important to remember that it is necessary to frequently change the position of the patient's body to avoid the occurrence of bedsores. It is necessary to use special pads that are placed under the tailbone, lower back and heels. A massage is a must. If the victim is conscious, breathing exercises should be performed. After consultation with a doctor and the absence of contraindications, you can begin to bend and straighten your limbs at the joints.

Conclusion

So, the spinal cord is the center in the human nervous system. It is responsible for sending impulses to the entire body. At the slightest disturbance of the spinal cord, serious consequences associated with musculoskeletal system and vegetative functions. There are several levels of disease development that are directly related to spinal cord disease. Each level is assigned specific symptoms. The main dysfunctions that occur are:

  • vegetative system;
  • urethra;
  • stomach;
  • intestines.

In addition, the motor function of a person, his 4 or 2 limbs is impaired, and the sensitivity of the skin is significantly reduced. When the first symptoms appear, you should immediately consult a specialist doctor who will conduct an examination and prescribe the necessary course of treatment.

On this moment There are several methods for diagnosing a patient, which make it possible to almost immediately determine the cause of damage to the spinal cord, see fractures, bruises and their location.

Treatment is carried out with medications or surgery (in certain situations, or if drug therapy does not help).

When providing first aid, you should remember that if you do everything on time and correctly, you can save a person’s life. Most disorders that affect the spinal cord can be fatal. When caring for patients, you need to change their position more often, do massage and breathing exercises. This way you can help the victim recover as quickly as possible.

Pathologies of the spinal cord quite often occur in a latent form, and are detected only when the symptoms of the disease are pronounced and correction of the condition is difficult. One such example is tethered spinal cord syndrome, a disease that is more often diagnosed as a congenital disorder.

Doctors often denote the name of the pathology by an abbreviation consisting of the first letters of the term - FSM, as well as synonyms: rigid terminal or terminal filum syndrome, tethering syndrome.

The concept of “fixed spinal cord” means immobility, constancy. According to medical meanings, in fixation syndrome, attachment of the spinal cord to the spinal column is observed, as a result of which the mobility of the vertebrae is lost. According to physiological concepts, the spinal cord is represented as a substance consisting of white and gray matter. In its natural state, the spinal cord should be free-floating, that is, it should move in the space surrounding it. This structure provides reliable protection for the internal organ in the event of various types of damage or injury.

Tethered spinal cord syndrome is most often observed in the lumbar spine. Doctors have not come to a clear opinion as to why this pathology may develop. Science has proven that in most cases the disease is congenital and actively manifests itself in preschool children. Statistics say that in 80% of cases, fixed spinal syndrome is diagnosed in children aged 4 to 5 years. The provoking factor in the development of the disease is deviations in the development of the lower part of the spinal cord, as well as destruction of brain tissue.

Possible causes that can trigger the development of tethered spinal cord syndrome may be:

  • the presence of a tumor process in the body or the presence of other neoplasms;
  • frequent spinal trauma;
  • presence of scars after surgery;
  • Chiari malformation (“invasion” of the spinal cord into the upper part of the spinal region);
  • spina bifida (diastematomyelia);
  • structural abnormalities in the lower spine.

The above reasons for the development of pathology prove that tethering syndrome can not only be congenital and occur in children, but can be acquired as a result of surgical interventions on the spine and during the formation of tumors or cysts.

Clinical picture

The general symptoms of stiff end syndrome can vary greatly depending on the age category of the patient.

With the congenital nature of the disease, the first signs appear in the baby at an early age, when he begins to walk and the load on the spine increases. Deviations in children occur in the form of clubfoot and gait disturbances. The characteristics of children with the syndrome are as follows: it is very difficult for the baby to move; every step he takes is accompanied by acute painful sensations. Symptoms get worse with age.

With the development of fixation apparatus syndrome, deformation of the bones of the feet begins, after which disturbances appear in the skeleton, and scoliosis is formed. As it progresses, the internal systems also suffer, the patient suffers from the activity of the genitourinary system (enuresis, incontinence or leakage of urine, the presence of pathogenic infections, the inability to control the process of urination, etc.).

Expert opinion

Pain and crunching in the back and joints over time can lead to dire consequences- local or complete restriction of movements in the joint and spine, up to disability. People, taught by bitter experience, use a natural remedy to cure joints, which is recommended by orthopedist Bubnovsky... Read more"

In a complicated form, the pathology also “affects” the functioning of the digestive tract, this is expressed in the manifestation of the following ailments: disturbances in the process of bowel movement, indigestion, loss of control over bowel function.

The difference in the clinical picture between an adult and a child is that with age the symptoms of the pathology are more aggressive and are often irreversible.

The only correct diagnostic method is MRI; only with the help of a tomograph can one determine the true state of the terminal filum of the spinal cord and the degree of pathology. Based on the MRI results, the need for surgical intervention is determined.

It is important to note that doctors are trying to minimize the need for interventions on the spine. This internal organ has a rather complex structure, and any operation can result in the most unpredictable consequences for the patient.

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Treatment

After the diagnosis has been clarified, only a small percentage of patients remain under medical supervision; most patients undergo surgery, which is aimed at freeing the fixed brain and restoring its basic functions.

The method of surgical treatment is determined after analyzing the condition of the terminal filum. If the terminal filament is slightly shortened or somewhat denser natural state, the patient is prescribed laminectomy, an operation that does not involve massive manipulations in the lumbosacral region.

If tethering syndrome is more severe, then the patient is indicated for a full-fledged surgical intervention, which is performed under a powerful microscope. Radical treatment consists of the following steps: after opening the spine, the fixed spinal cord is separated. It often happens that one operation is not enough. This is observed in children in whom the syndrome actively progresses as their bones grow. In this case, several sequential operations are performed, and sometimes vertebrae (1 or 2) are removed to reduce the length of the spinal column.

After the operation, the patient’s pain and some neurological signs disappear, but other symptoms (numbness, loss of sensation in the lower extremities) continue to persist, since they are caused by traumatic damage to the nerve endings.

Rehabilitation after surgery

Each type of operation has its own deadlines. On average, the rehabilitation period takes 6 months. For a simple operation it can last 3 months, for a more complex operation it can take up to a year.

There are 3 stages of rehabilitation after spinal surgery:

  1. The early rehabilitation stage is the prevention of complications, relapses, relieving pain and swelling, wound healing. At this stage, the patient is advised to take painkillers and anti-inflammatory drugs. Any physical exercise strictly contraindicated. The duration of the stage is several weeks.
  2. Late rehabilitation stage - restoration of basic body functions under the control of a trainer or massage therapist. The patient is prescribed a course of exercise therapy, massage, and physiotherapy. The duration of the stage is 2 months.
  3. The third stage is individual for each patient; its duration can be several months or several years. For a certain time, the patient is prohibited from lifting weights, engaging in active sports, making sudden movements, bending, etc.

How to forget about back and joint pain?

We all know what pain and discomfort are. Arthrosis, arthritis, osteochondrosis and back pain seriously spoil life, limiting normal activities - it is impossible to raise an arm, step on a leg, or get out of bed.