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Neurology (Expert Forum)
pain,scoliosis,pass release of cord in 4yr old
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pain,scoliosis,pass release of cord in 4yr old
by katiesmom1976, Apr 11, 2002 12:00AM
hi i have a 4yr old little girl who had closed spinal bifida she had basicall LMC-TCS and a dermal sinus,missing 2-3 sacreal vertebre,L1-2 self fussed,L2-4 are hemivertebre. she had her spinal surgery to remove a small amount of the lipoma and dermal sinus and released her cord on 11-29-00. about 4mo ago she started to change her gaite and limp alittle more,since then she has had 4r ound of sever back pain leaving her with a stiff neck due to contractured muscles and one time she had a hard time walking the following morning due to stiffness after anight of spasms. he scoliosis is at about 30-35degrees right now and extends off of L3 and is a levo convex curve. we are currentally in the middle of finding her problem she had a neg MRI that showed no tethering and cord down at L2-3(was L5),and no changes in the lipoma from teh previous surgery even though some ahd been removed. her bone scan on the spec portion showed an incred uptake on the left side from L2-5.
1.we thing her growth plates are messed up in her L spine can this cause pain if the bone growth is uneven exspecially during growth spurts if her plates are off what is the treatment for it?
2.are you aware of any new fussion methods for young kids that are possibally laproscopic or are they not trying them yet on kids?
3.what are the posssabilities we are see the first sign of a tether and it just isnt showing on ht mri yet?
thanks for any help we are very worried about her exspecially her age being so young.
joanna
1.we thing her growth plates are messed up in her L spine can this cause pain if the bone growth is uneven exspecially during growth spurts if her plates are off what is the treatment for it?
2.are you aware of any new fussion methods for young kids that are possibally laproscopic or are they not trying them yet on kids?
3.what are the posssabilities we are see the first sign of a tether and it just isnt showing on ht mri yet?
thanks for any help we are very worried about her exspecially her age being so young.
joanna
Doctor's Answer
by CCF-Neuro-M.D.-JT, Apr 18, 2002 12:00AM
Very sorry to hear about your daughter's condition. This is obviously a complex case that requires careful review of her spinal anatomy pre and post-surgically for a thorough evaluation. The growth plate issue is a thought but not the first thing that comes to mind. One thing that could be causing some of her problems is infection as patients with spinal defects are predisposed to meningitis. This could potentially cause some of her symptoms (like stiff neck), although typically patients are more sick with fever, lethargy, etc...
It is also possible that the cord was not completely released (hard to say as I have not personally examined your daughter nor reviewed your films). You are correct in assuming that some of these symptoms could be consistent with a tethered cord or lipoma attached and anchoring the cord (especially if not all of the lipoma was removed). As she got older and taller, the cord became progressively stretched resulting in her spasticity and back pain. It may be worth getting a second opinion at a major academic/clinical pediatric center to see what is going on. They can either review or repeat the MRI of the spine. Incidentally, an MRI of the cervical spine is important to rule out other defects such as arnold-chiari malformation which can cause other porblems. Before considering any kind of fusion procedure which may not help her symptoms, make sure nothing else is going on with the cord which very well could be the real problem. Talk to your pediatrician about getting a second opinion sooner rather than later as release of a partially tethered or anchored cord could provide some relief of symptoms or at the very least prevent further damage. Best of luck.
It is also possible that the cord was not completely released (hard to say as I have not personally examined your daughter nor reviewed your films). You are correct in assuming that some of these symptoms could be consistent with a tethered cord or lipoma attached and anchoring the cord (especially if not all of the lipoma was removed). As she got older and taller, the cord became progressively stretched resulting in her spasticity and back pain. It may be worth getting a second opinion at a major academic/clinical pediatric center to see what is going on. They can either review or repeat the MRI of the spine. Incidentally, an MRI of the cervical spine is important to rule out other defects such as arnold-chiari malformation which can cause other porblems. Before considering any kind of fusion procedure which may not help her symptoms, make sure nothing else is going on with the cord which very well could be the real problem. Talk to your pediatrician about getting a second opinion sooner rather than later as release of a partially tethered or anchored cord could provide some relief of symptoms or at the very least prevent further damage. Best of luck.
joanna
joanna