Of great importance in the development of diseases of the spine are certain developmental anomalies or acquired changes in the spine. Congenital anomalies of the spine include non-closure of the vertebral arch (Spina bifida), sacralization, lumbarization, spondylolisthesis (slipping of the vertebra forward or backward).
These anomalies in the development of the spine are not in themselves factors that injure the nerve roots, but may indicate any developmental defects in the nerve tissue itself and indicate the general dysraphic status of the patient. Spine developmental options are important for reducing its static stability. The lumbar spine bears the weight of the erect torso. This is the most mobile part of the spine, and therefore the human lower back is most often exposed to traumatic factors.
Klippel-Feil syndrome (short neck syndrome)
Defects in the development of the spine are often found in the cervical and lumbosacral regions. In the cervical spine, along with occipitalization of the atlas and mixing of the CI vertebra in relation to the CII vertebra, short neck syndrome (Klippel-File) can be observed. The cervical vertebrae are a shapeless bone mass. Patients have no neck (the head lies directly on the body), limited mobility of the head, the border of the hair is low, there is scoliosis or kyphoscoliosis.
From the neurological side, this disease either does not manifest itself or is accompanied by cervical radicular syndrome and pyramidal signs. Often, Klippel-Feil syndrome is combined with the splitting of the lumbar vertebrae (spina bifida) and the presence of cervical ribs, sometimes only the transverse process is enlarged, sometimes it comes to the formation of true ribs.
Accessory cervical rib syndrome
Accessory cervical rib syndrome can clinically manifest itself under the influence of adverse factors (cold, trauma, infection). In many cases, the additional cervical ribs do not show anything about themselves and turn out to be an accidental find. The clinical manifestations of the accessory cervical ribs are characterized by the presence of neuralgic pain in the shoulder, which sometimes extends to the entire limb.
Usually, there are vasomotor and trophic disorders (pale, cyanotic cold skin, sweating, increased pilomotor reflex). Muscle weakness and atrophy sometimes join. The presence of autonomic disorders, as well as, in some cases, the sympathetic nature of the pain indicate trauma by the accessory ribs of the cervical sympathetic fibers.
Split vertebra (spina bifida)
The most common developmental defect of greatest practical importance is spina bifida. In the overwhelming majority of observations, cleavage consists of non-overgrowth of the vertebral arches. It is extremely rare to observe splitting directly of the vertebral body. Most often, non-closure of the arches is observed either in the LV lumbar or in the SI sacral vertebra. In other parts of the spine, the arches are not clogged less often.
Distinguish between the closed and open splitting of the vertebrae.
Closed splitting of the vertebrae (spina bifida oculta) is more common. In most cases, closed spina bifida (spina bifida oculta) is not accompanied by any neurological disorders. The only exception is bed-wetting.
With the closed splitting of the vertebrae (spina bifida oculta), there may also be mild pain in the lumbosacral region. The resulting cicatricial changes in the area of the roots cause neurogenic disorders: paresis of the legs with loss of tendon reflexes, radicular sensitivity disorders, trophic and vasomotor symptoms (ulcers, edema, local hypertrichosis, skin changes).
Open spina bifida is much less common (one child per 1000–1500 newborns) and is a more severe degree of developmental defect of the spine.
Usually, open splits of the vertebrae are combined with dysplasia of the spinal cord, membranes, and roots. Through the existing splitting of the vertebrae, the substance of the spinal cord and membrane protrudes.
Meningocele and meningomyelocele
Severe forms of hernia of the spinal cord are accompanied by severe disorders of motor, sensory and pelvic functions, trophic disorders.
In severe cases, splitting occurs not only in the spine but also in the spinal cord. The protruding hernial sac is not covered with muscles and skin; its wall is the posterior surface of the spinal cord (meningomyelocele).
In more favorable observations, the brain substance is not changed, and only the membranes (meningocele) are part of the hernial sac.
Among congenital malformations is diastematomyelia, in which the spinal cord in the caudal (lower) section is divided along the length of the bone, cartilaginous or fibrous septum, and is fixed by it, which delays its growth and upward displacement. This anomaly is often combined with spina bifida and has a clinical picture close to it.
Fixation of the spinal cord and its membranes leads to low cone stance and can cause Arnold-Chiari syndrome (a developmental defect in the brain), which can also be caused by spina bifida, congenital low spinal cord stance, short spinal roots.
Sacralization and lumbarization
It is also worth mentioning the sacralization of the LV of the lumbar vertebra when fusion with the SI sacral vertebra occurs, and the lumbarization of the SI sacral vertebra when it is separated from the sacrum and transformed into the LVI lumbar vertebra. Clinically, sacralization and lumbarization can sometimes manifest themselves as a radicular syndrome along with the L5 and S1 nerve roots. The causes of defects in the development of the spinal cord and spine are the same as for anomalies and defects of the brain and skull.
Congenital spinal instability (congenital spondylolisthesis) is a type of congenital anomaly of the structures of the spinal column. It is expressed in the form of underdevelopment of the supporting and fixing bone structures and the ligamentous apparatus. In the case of congenital instability of the spine, there is excessive mobility, which can lead to compression of the nerve roots, the diameter of the spinal cord, and spinal vessels.
Treatment of spinal malformations
Radicular symptoms with anomalies in the development of the spine are treated conservatively. Only with a persistent syndrome that is not amenable to drug and physical therapy, do they resort to surgical methods - removal of cicatricial changes, adhesions, additional cervical ribs, etc.
Spinal cord hernias (Meningocele and meningomyelocele) are treated with surgery. Good results are observed when the hernial sac consists only of membranes (meningocele). The prognosis for life is satisfactory, except cases in which spinal dysplasia occurs.
Depending on the severity of the manifestations and the causes of back pain in the patient, the following therapeutic actions are possible:
- drug therapy (NSAIDs, analgesics, hormones)
- therapeutic injections - injections of drugs into the cavity of the intervertebral joint, spinal canal, trigger points in the muscles
- manual therapy (muscle, articular and radicular technique)
- surgical treatment
Intervertebral joints (facet joints) can also be treated with blockages when conventional treatment is not beneficial. Usually, low doses of anesthetic and cortisone injected into the lumen of the affected joint are sufficient for this.
When combined with a properly selected physiotherapy regimen, these blockages can have a good and long-term effect on lumbar and sacral pain.
Wearing a semi-rigid lumbosacral corset helps to limit the range of motion in the lumbar spine. This helps to reduce pain in the area of inflammation of the intervertebral joints and relieve excessive protective tension and spasm of the back muscles.
In such a corset, the patient can move independently at home and on the street, sit in the car, and at the workplace. The need to wear a corset disappears as soon as the back pain goes away.
There are several types of semi-rigid lumbosacral corsets. All of them are selected in size and can be used repeatedly in case of recurrence of back pain.