Spinal cord fissure

　　The occurrence mechanism of spinal cord fissure is believed by some to be caused by factors other than nerves, that is, the abnormal development of vertebral bones; some people also believe that it is caused by the abnormal development of nerves, followed by the abnormal development of vertebral bones. The spinal cord is divided into left and right, with the hard meningeal tube accompanying the split and non-split types. That is, Type I: double meningeal sac and double spinal cord type, that is, the spinal cord is completely separated by fibrous tissue, cartilage, or bone spurs at the longitudinal fissure, divided into two, each with its own hard meningeal and arachnoid membrane, and the spinal cord is pulled by the separator, causing symptoms. Type II: common meningeal sac and double spinal cord type, the meninges are often separated by fibrous septa at the longitudinal fissure, into two parts, but with a common hard meningeal and arachnoid membrane. In terms of the etiology of the disease, it is still unclear at present. It is mainly related to the genetic AR inheritance.

　　The bony septum of diastematomyelia compresses, cuts the spinal cord, causing compression of the spinal cord at different parts, especially at the end of the spinal cord. With the growth of the body, the spinal cord, especially the end of the spinal cord, is continuously pulled and cut, causing spinal cord injury. At the same time, the blood supply vessels of the spinal cord become thinner, blood circulation is obstructed, and further damage to the spinal cord is exacerbated.

　　In terms of gender and age of onset, the disease is more common in girls. Hong Yi et al. (2001) reported that from October 1989 to October 2000, 117 cases were treated, including 16 males and 101 females, aged 1.8 to 64 years, with an average age of 17.8 years, and the age of onset of symptoms was 1 to 32 years, with an average of 10 years. Muller reported a group of 43 cases, with an average age of onset of symptoms at 6 years (1 to 13 years).

　　In terms of symptoms and signs, the main symptoms are lumbar pain, lower limb pain, lower limb sensory and motor impairment, foot deformities, and bladder dysfunction. Among Hong Yi's 117 cases, there were 62 cases (53％) with lumbar pain or lower limb pain, 85 cases (72.6％) with lower limb sensory and motor impairment, including 23 cases of mild paralysis, 46 cases of moderate walking difficulties, and 16 cases of severe inability to walk independently. Foot deformities (such as talipes) were found in 98 cases (83.8％), and bladder dysfunction in 44 cases (37.6％).

　　Diastematomyelia is a rare congenital spinal cord developmental malformation in which the spinal cord is segmented apart in the sagittal plane. It is often accompanied by other congenital spinal deformities, accounting for 4％～9％ of congenital spinal deformities. The etiology and pathogenesis of this disease are not yet fully understood and may be related to factors such as inheritance, infections during pregnancy, vitamin deficiency, and radiation. It can be inherited as an autosomal recessive trait.

　　Since it is a congenital disease, there are no special preventive measures for this disease. Once diagnosed, especially for those with neurological symptoms, surgical treatment is recommended to relieve the traction of abnormal structures such as septa and fibrous bands on the spinal cord, and restore neurological function. For those with a young age and no neurological symptoms, some advocate follow-up observation, while others advocate early preventive surgery.

　　The main examination for diastematomyelia is imaging examination.

　　Imaging examination

　　In addition to the examination of lower limb sensation and movement, anal area examination, there are often abnormalities in the skin of the back or lumbar area, such as dimple-like skin凹陷72.6％，（78.6％），such as congenital scoliosis, congenital kyphoscoliosis, absence of laminae, sacral abnormality, concealed spina bifida, etc., X-ray films showing bone spurs within the spinal canal in 41％;

　　CT shows 62% with intramedullary diaphragm;

　　MRI is the best examination, showing 53.8% with bony diaphragm, 24% non-bony diaphragm, and 100% with dual spinal cord structure (mainly split). The vast majority of cases show spinal cord located between L2 to L4, with more than half having lipomas, and teratomas can also be seen.

　　Spinal cord injury patients can eat more fruits, vegetables, beans, brown rice, whole wheat, etc., to meet the basic needs of the body. Drink 3000 milliliters of water every day, and ensure that the water quality is clean.

　　Do not drink too much alcohol, as alcohol can cause many serious problems to spinal cord injuries, such as bedsores.

　　The treatment of spinal cord splits includes two parts: one is the resection of the diaphragm, which involves the resection of the vertebral lamina at the location determined by imaging, opening the double spinal canals, resecting the diaphragm, and cutting the adhesions pressing on the spinal cord and dura mater; the other is to deal with coexisting problems, such as the resection of the tense filum terminale, the resection of teratomas, and the separation and resection of lipomas and nerve adhesions, which should be done with microsurgical techniques as much as possible. Complete separation is difficult, and excessive operations can cause exacerbation of neurological symptoms.

　　The treatment result is limited, about 1/4 of the cases can obtain improvement in neurological symptoms, Hong Yi et al. followed up 105 cases for 0.5 to 10 years, on average 3.5 years, with significant improvement in lumbar pain and lower limb pain by 31.4%, moderate improvement by 27.6%, mild improvement in lower limb movement by 53%, no improvement by 20%, deterioration by 7.6%, bladder function, which belongs to upper motor neuron damage, showed significant improvement in up to 80%, no change by 12%, deterioration by 4%, those belonging to lower motor neuron showed mild improvement by about 50%, but deterioration by 47.3%, rectal function showed mild improvement by 14.2%, deterioration by 85.7%, foot deformities showed no change, and there were those who deteriorated. It can be seen that in tail surgery, it is very easy to cause increased injury by separating from lipomas or other adhesions.