Results of Surgical Treatment of Occult Spinal Dysraphisms—A Single Centre Experience
Occult spinal dysraphisms (OSDs) are caused by various defects in the embryogenesis of the spinal cord and represent an obstacle to the ascent of the conus, which allows the conus to pass from the lower levels of the spinal canal to the final position between L1 and L2 during normal foetal life. Whe...
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| Format: | Article |
| Language: | English |
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MDPI AG
2024-03-01
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| Series: | Diagnostics |
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| Online Access: | https://www.mdpi.com/2075-4418/14/7/703 |
| _version_ | 1827286910290100224 |
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| author | Peter Spazzapan Tomaz Velnar Nina Perosa Andrej Porcnik Borut Prestor |
| author_facet | Peter Spazzapan Tomaz Velnar Nina Perosa Andrej Porcnik Borut Prestor |
| author_sort | Peter Spazzapan |
| collection | DOAJ |
| description | Occult spinal dysraphisms (OSDs) are caused by various defects in the embryogenesis of the spinal cord and represent an obstacle to the ascent of the conus, which allows the conus to pass from the lower levels of the spinal canal to the final position between L1 and L2 during normal foetal life. When an OSD tethers the spinal cord at the lower levels, it can lead to neurological symptoms, better known as tethered cord syndrome. Surgical treatment of OSD is primarily aimed at untethering the spinal cord. In asymptomatic patients, this can protect against the long-term development of neurological deficits. In symptomatic patients, this can halt or limit the progression of existing symptoms. The aim of this study is to examine all paediatric and adult patients diagnosed with OSD and treated in the Department of Neurosurgery at the University Medical Centre Ljubljana during the 5-year period of 2016–2021. All patients diagnosed with OSD during this period were included in the study. Patient characteristics, treatment modalities and outcomes were studied with the aim of describing the differences between the paediatric and adult population and defining the rationality of treating these pathological conditions. We included in the study 52 patients with 64 occult dysraphic lesions. Adults (>18 years old) represented 15/52 (28.8%) of all patients, while 37/52 (71.8%) were children. The most common OSDs were conus lipomas, followed by dermal sinus tracts, filum terminale lipomas and split cord malformations. Surgical treatment was performed in 35/52 (67.3%) cases, while conservative management was chosen in 17/52 (32.6%) cases. The preoperative presence of symptoms was statistically higher in adults than in children (<i>p</i> = 0.0098). Surgery on complex spinal cord lipomas was statistically related to a higher rate of postoperative neurological complications (<i>p</i> = 0.0002). The treatment of OSD is complex and must be based on knowledge of the developmental anomalies of the spine and spinal cord. Successful surgical treatment relies on microsurgical techniques and the use of neuromonitoring. Successful treatment can prevent or limit the occurrence of neurological problems. |
| first_indexed | 2024-04-24T10:47:57Z |
| format | Article |
| id | doaj.art-90fe4d2b90444a43873a240ed4998d24 |
| institution | Directory Open Access Journal |
| issn | 2075-4418 |
| language | English |
| last_indexed | 2024-04-24T10:47:57Z |
| publishDate | 2024-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj.art-90fe4d2b90444a43873a240ed4998d242024-04-12T13:16:44ZengMDPI AGDiagnostics2075-44182024-03-0114770310.3390/diagnostics14070703Results of Surgical Treatment of Occult Spinal Dysraphisms—A Single Centre ExperiencePeter Spazzapan0Tomaz Velnar1Nina Perosa2Andrej Porcnik3Borut Prestor4Unit of Paediatric Neurosurgery, University Medical Centre Ljubljana, 1000 Ljubljana, SloveniaUnit of Paediatric Neurosurgery, University Medical Centre Ljubljana, 1000 Ljubljana, SloveniaDepartment of Neurosurgery, University Medical Centre Ljubljana, 1000 Ljubljana, SloveniaDepartment of Neurosurgery, University Medical Centre Ljubljana, 1000 Ljubljana, SloveniaDepartment of Neurosurgery, University Medical Centre Ljubljana, 1000 Ljubljana, SloveniaOccult spinal dysraphisms (OSDs) are caused by various defects in the embryogenesis of the spinal cord and represent an obstacle to the ascent of the conus, which allows the conus to pass from the lower levels of the spinal canal to the final position between L1 and L2 during normal foetal life. When an OSD tethers the spinal cord at the lower levels, it can lead to neurological symptoms, better known as tethered cord syndrome. Surgical treatment of OSD is primarily aimed at untethering the spinal cord. In asymptomatic patients, this can protect against the long-term development of neurological deficits. In symptomatic patients, this can halt or limit the progression of existing symptoms. The aim of this study is to examine all paediatric and adult patients diagnosed with OSD and treated in the Department of Neurosurgery at the University Medical Centre Ljubljana during the 5-year period of 2016–2021. All patients diagnosed with OSD during this period were included in the study. Patient characteristics, treatment modalities and outcomes were studied with the aim of describing the differences between the paediatric and adult population and defining the rationality of treating these pathological conditions. We included in the study 52 patients with 64 occult dysraphic lesions. Adults (>18 years old) represented 15/52 (28.8%) of all patients, while 37/52 (71.8%) were children. The most common OSDs were conus lipomas, followed by dermal sinus tracts, filum terminale lipomas and split cord malformations. Surgical treatment was performed in 35/52 (67.3%) cases, while conservative management was chosen in 17/52 (32.6%) cases. The preoperative presence of symptoms was statistically higher in adults than in children (<i>p</i> = 0.0098). Surgery on complex spinal cord lipomas was statistically related to a higher rate of postoperative neurological complications (<i>p</i> = 0.0002). The treatment of OSD is complex and must be based on knowledge of the developmental anomalies of the spine and spinal cord. Successful surgical treatment relies on microsurgical techniques and the use of neuromonitoring. Successful treatment can prevent or limit the occurrence of neurological problems.https://www.mdpi.com/2075-4418/14/7/703dysraphismstethered cordsphincter dysfunctionparesispainorthopaedic deformation |
| spellingShingle | Peter Spazzapan Tomaz Velnar Nina Perosa Andrej Porcnik Borut Prestor Results of Surgical Treatment of Occult Spinal Dysraphisms—A Single Centre Experience Diagnostics dysraphisms tethered cord sphincter dysfunction paresis pain orthopaedic deformation |
| title | Results of Surgical Treatment of Occult Spinal Dysraphisms—A Single Centre Experience |
| title_full | Results of Surgical Treatment of Occult Spinal Dysraphisms—A Single Centre Experience |
| title_fullStr | Results of Surgical Treatment of Occult Spinal Dysraphisms—A Single Centre Experience |
| title_full_unstemmed | Results of Surgical Treatment of Occult Spinal Dysraphisms—A Single Centre Experience |
| title_short | Results of Surgical Treatment of Occult Spinal Dysraphisms—A Single Centre Experience |
| title_sort | results of surgical treatment of occult spinal dysraphisms a single centre experience |
| topic | dysraphisms tethered cord sphincter dysfunction paresis pain orthopaedic deformation |
| url | https://www.mdpi.com/2075-4418/14/7/703 |
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