Tense Spinal Cord Syndrome
Every parent’s nightmare is the possibility of congenital or acquired diseases in their babies. Brain and Nerve Surgery Specialists warn parents about one of these diseases, Tense Spinal Cord Syndrome. Specialist doctors say, “The earlier tense spinal cord syndrome, which occurs congenitally or later due to stretching of the spinal cord and can cause orthopedic deformities in the feet, weakness in the legs, pain in the waist or legs, spinal curvature and urinary incontinence, is understood, the more successful its diagnosis and treatment will be.” “On the other hand, when treatment is delayed, it causes problems that are difficult to compensate for a lifetime,” he says.
It is a syndrome in which the spinal cord ends lower than the L1 and L2 vertebral level where it normally ends, and as a result, the spinal cord is stretched, and nervous system, orthopedic and urinary system problems can occur together. The incidence of tethered spinal cord syndrome (GOS) ranges from 5 to 25 per 100,000 births. It is twice as common in female babies as in male babies. It should not be forgotten that tethered spinal cord syndrome can be seen in adulthood, unlike childhood.
The most common causes include myelomeningocele, where the spinal cord is outside in the form of a sac, diastomatomyelia (split spinal cord syndrome), and dermal sinus tract, which is open in the skin of the hip area in newborns. Complaints in newborns, infancy and adults vary according to age. In childhood, loss of strength in the legs, gait disorders, urological problems, spinal deformities such as spinal curvature, deformities in the feet, increased hair growth in the waist area and skin changes are observed. In GOS, which is seen in adulthood, pain in the genital area, urinary problems and loss of strength in the legs can be observed. Waist and leg pain are more common in patients with GOS, which is diagnosed in adulthood rather than childhood. Babies born with intense hair growth in the waist area should be evaluated for GOS and a brain surgery doctor should be consulted. Diagnosis can be easily made with MRI requested by the neurosurgeon.
It is difficult to evaluate urinary system functions in infancy. Especially the age at which children receive toilet training varies from person to person and from society to society, although they are 4-5 years old;
- Urinary incontinence during the day and night,
- Frequent urination,
- Urinary tract-related tests and imaging methods should be performed in children who complain of frequent urinary tract infections and complete inability to urinate.
- Complaints in children with GOS are progressive, and symptoms may be present from birth or may appear over time and progress rapidly. Therefore, it is very important for these children to undergo a thorough physical examination by pediatricians and to consult a neurosurgeon when suspicious skin, foot or spine-related examination findings are detected, for early diagnosis and treatment.
- In all patients with suspected GOS, the diagnosis is made by MRI. Another important diagnostic test is urinary system tests in patients with GOS detected by MRI. Urinary system tests are very important in diagnosis, treatment and follow-up.
- GOS is a disease that can be treated with early diagnosis. The aim of treatment in GOS is to eliminate the cause of tension in the spinal cord. Nervous system findings in GOS are progressive and recovery is not possible, especially after urinary system problems occur. For this reason, the decision for surgical treatment should be made as soon as possible and nervous system symptoms should not be waited for.