[Painful sacral rachischisis: considerations on the etiopathogenesis and treatment]

The Authors present 13 cases of patients with a painful spina bifida operated between 1965 and 1974. This exiguous number of patients shows that the surgical indication is placed only after a symptoms's severe valuation and the inefficacy of bloodless therapy. The 3 poor results were due to the coexistence of other diseases. The pain is caused by skeletal insufficiency. It would suitable to carry out a close research as Computerized Axial Tomographic Scanning and to join an intervention of arthodesis intersomatic when there are another malformations.

Human tail and other abnormalities of the lumbosacrococcygeal region relating to tethered cord syndrome

The author describes 2 instances of surgical exploration and treatment of human tail, which he believes is important in relieving tethered cord syndrome. Simple excision of human tail or other suspicious abnormalities may prevent the diagnosis and important early treatment of tethered cord syndrome.

Practical problems in selection of spina bifida infants for treatment in the USA

Seventy-five spina bifida infants were studied for results of selectin for treatment. The 31 nonoperated infants had a survival rate of 70% at 18 months, a figure higher than anticipated. Practical difficulties in adhering to the selectin protocol and controlling medical management in a large North American city were noted. Thirty-three surveyed parents of surgically repaired infants reported satisfaction with family function during the 18 months follow-up but discrepant scores increased with time.

Cranio-orbital correction for massive enlargement of the cranial vault

A case is reported in which an immense cranial vault was reduced as part of the rehabilitation of a patient with severe hydrocephalus who had preservation of the intellect. This patient was selected carefully, and we do not advocate such procedures on every hydrocephalic. This patient was recumbent and bedridden prior to the procedure because of the size and weight of his head, but he was able to move freely in a wheelchair and attend a special school after the reduction of the skull.

[Clinico-radiological correlation and treatment of patients with absence of lumbar vertebral arch fusion]

The authors observed 88 patients (18 women and 70 men) aged 16 to 61 years with lack of lumbar vertebral arch fusion (spina bifid occulta without spinal cord involvement). In 63 cases the clinical symptom complex was that of sciatic pains, in the remaining 25 cases no neurological defect was found. In 63 cases operation was done and 45 of them intervertebral disc prolapse was found. The decision to operate was based on the refractoriness and intensity of pain, presence of neurological defect and radiculography performed in 36 cases. It is stressed that such high proportion (51%) of cases with spina bifida coexistent with lumbar disc prolapse calls for a careful analysis of the cause of pain in patients with spina bifida.

Spinal lipomas in infancy and childhood

The clinical course of 42 children with lipomatous lesions of the lower spine is reviewed. Good neurological exam, IVP and myelography are considered essential components of the preoperative studies. The surgical aim is to free all intra- to extradural adhesions with dural grafting, if necessary. The results suggest that early corrective surgery within the first few weeks to months of life is the most satisfactory approach to preserving normal neurological and urological function in these children. 88% of children not operated on early developed progressive loss of neurological function and while delayed surgery frequently stopped progression of the disease it rarely returned the children to a normal state.

[Surgical and apparative treatment of patients with meningomyelocele with special reference to their hip problems]

Children with thoracic lesions should have hip surgery done only if this is necessary for the child to be able to walk with braces. In lumbar lesions hip surgery and especially SHARRARD'S procedure of iliopsoas transfer is done to establish muscular balance. The amount of braces for walking can thus be reduced. In sacral lesions there is no place for hip surgery, as functional gain would not be expected.

Cutaneous signs of spinal dysraphism. Report of a patient with a tail-like lipoma and review of 200 cases in the literature

The term "spinal dysraphism" was coined in 1940 by Dr Lichtenstein to designate incomplete fusion or malformations of structures in the dorsal midline of the back, particularly congenital abnormalities of the vertebral column and spinal cord. Raphes develop on the face and head, brancheal arches, sternum, and spinal column. When dysraphism occurs in these sites, failure of closure of fontanelles, cleft lip and palate, brancheal cysts, and abnormalities of the ribs and spine result. A review of 200 cases of occult spinal dysraphism showed the condition to be more common in female patient and to be associated with cutaneous signs in more than 50% of instances. The age at which neurologic symptoms appeared in recorded cases is from birth to 76 years, the average being three years. A case of spinal dysraphism with a tail-like cutaneous structure is presented. The cutaneous manifestations accompanying spinal dysraphism that may lead to early recognition of this syndrome and early institution of treatment are discussed.

Spina bifida: epidemiological data from a pilot study

The epidemiology of spina bifida has great geographical variation. A small unselected group of patients were registered as part of a pilot project on infantile hydrocephalus. Twenty-two patients, born 1963-69 in Vejle county, Denmark were identified, giving an incidence of 0.77 per 1000 births. The mothers had 26 pregnancies prior to the spina bifida children; 14 of these had resulted in normal viable infants (54%). Seven of the patients had other congenital malformations, unrelated to the neural tube defect. All unoperated patients died. Four of 10 operated children were alive at age 7-12 years, three of them without handicap.

Intermittent non-sterile catheterization of children suffering from spina bifida: an alternative to urinary diversion

Ten children suffering from spina bifida with recurrent urinary tract infections and incontinence have been treated by intermittent non-sterile catheterization both at home and at school. Six have shown improvement in both infection rate and incontinence. Two have undergone urinary diversion, and two have had an equivocal result.

The management of kyphosis in patients with myelomeningocele

Kyphosis in myelomeningocele is a progressive condition, which can lead to severe deterioration of function and skin ulceration over the apex of the kyphus. Since bracing is impractical, surgical correction and stabilization is the recommended method of management. Three different techniques are in current use. An anterior procedure using a plate and u-bolt shackles, an anterior approach using a bone strut, and a posterior approach excising a wedge, and the spinal cord if it is functionless. We recommend the wedge excision combined with posterior Harrington compression instrumentation and spinal fusion extending well above and below the resection. Regardless of the approach used, it is the long spinal fusion both anterior and posterior, which will maintain correction.

Acute elevation of intracranial pressure following transection of non-functional spinal cord

A spinal cord which is neurologically nonfunctional may be functioning as a conduit for CSF between the ventricular system and the spinal subarachnoid space. Interruption of this pathway can have catastrophic consequences unless there is an adequately functioning shunt.