(2)
Department of Orthopedics, Front Range Orthopedic Center, 1551 Professional Ln Suite 200, Longmont, CO 80501, USA
Take-Home Message
Strong association with congenital scoliosis
Definition
Longitudinal cleft of the spinal cord
Etiology
Abnormality of congenital fetal development
Pathophysiology
Longitudinal cleft that can fix the cord as the spine grows causing neurologic deficit, similar to a tethered cord
Radiographs
Ultrasound – in utero.
X-rays may show widening of the pedicles.
CT/myelography can best detect bony diastema.
MRI defines neurologic anatomy.
Treatment
Nonoperative
Observation
Operative
Surgery to resect and repair
Must deal with diastema operatively if also doing deformity correction
Complications
Dural leak
Retethering of neurologic structures
Bibliography
1.
Cheng B, Li FT, Lin L. Diastematomyelia: a retrospective review of 138 patients. J Bone Joint Surg Br. 2012;94(3):365–72. doi:10.1302/0301-620X.94B3.27897.
2 Myelomeningocele
Samuel E. Smith3
(3)
Department of Orthopedics, Front Range Orthopedic Center, 1551 Professional Ln Suite 200, Longmont, CO 80501, USA
Take-Home Message
Higher neurologic levels more likely to cause scoliosis
Pressure ulceration from sitting imbalance
Can have neurologic progression from tethered cord
Urosepsis common
Definition
Failure of the tissue closure causing midline defect
Etiology
Multifactorial
Diabetes
Folate deficiency during pregnancy
Pathophysiology
Midline defect that is sometimes just the bone, sometimes the bone and meninges, and sometimes the bone, meninges, and neural elements
Radiographs
X-rays: Monitor her spinal deformity especially.
MRI: If there is a change in neurologic status with respect to myelopathy, consider tethered cord.
CT scan: Better definition of bony anatomy for spine surgery.
Classification
Spina bifida occulta
Meningocele: Sac does not include neural elements.
Myelomeningocele: Sac includes neural elements.
Try to determine neurologic level for prognostic and treatment purposes.
Treatment
Bracing is not effective but observation can be appropriate.
When spine surgery is indicated, it often requires anterior/posterior approach because posterior arthrodesis is very difficult due to deficient posterior elements.
As with other neuromuscular deformities, fusion to the pelvis is indicated.
Complications
Infection risk with surgery high
Pressure sores
Failure fixation, failure of fusion
Urosepsis
DVT/PE
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