Abstract

STUDY ON SPINAL DYSRAPHISM IN TERTIARY CARE CENTRE, ANDHRA MEDICAL COLLEGE, VISAKHAPATNAM

Author(s): B. Hayagriva Rao 1 , K. S. Vara Prasad 2 , K. Indu Sekhar 3 , B. Raja Sekhar 4

Spinal dysraphism is a broad term including heterogeneous group of congenital spinal anomalies. Defects in the early embryologic age cause spinal dysraphism. Several environmental and genetic factors are noted for causing this congenital entity. Spinal dysraphism is broadly grouped in to two groups, closed (spina bifida occulta) and open type (spina bifida aperta). Transabdominal ultrasonography is best for prenatal diagnosis. The clinical features of spinal dysraphism include more than one symptom or sign. The neurological deficits depend on malformation of the neural placode and level of the defect. This retrospective study of 54 spinal dysraphism cases was done in king George Hospital, Visakhapatnam. The study period is from August 2013 to July 2015. The craniospinal MRI was done to all patients and radiological findings and associated anomalies recorded for planning of management of these patients. RESULTS The age ranges from one day to 17 years. The youngest was one day and oldest one 17 years in this study. The incidence is high in females 57.40% (n=31) than males 42.60% (n=23). Spina bifida aperta (open type) is present in 39(72.22%) and more common than Spina bifida occulta (closed) which is present in only in 15 patients (27.77%). The commonest site of occurrence of spinal dysraphism is the lumbo sacral region in 28 patients (51.85%). Most common finding is myelomeningocele in 33 (61.11%) cases, myelocele 4(7.47%). Lipomyelomeningocele 7(12.96%) is most common finding in closed type. The most common associated anomaly is hydrocephalus in 23(42.59%) patients and next common is Arnold chairi malformation type11 in 21(38.88%) cases. The most common postoperative complication is CSF leak in 11(20.37%) cases. Motor weakness in the form of paraparesis or paraplegia present in 29 patients preoperatively, out of which only 12(22.22%) improved. Major cases of sensory deficits (12 in 21 cases) did not improved and remained static. In the majority of cases (11, 20.37%) sphincter function remained status quo same as in the preoperative period. CONCLUSION A spinal dysraphism patient should receive treatment from an experienced multidisciplinary team including neonatologist, neurosurgeon, and plastic surgeon and rehabilitation experts. Inadequate treatment at peripheral centers should be avoided. Patient should be referred to higher tertiary centre where the complete team is available. The post-operative care is equally important to avoid complications and for better outcome.