Open spinal dysraphism

　　1. Open injury

　　It is often accompanied by spinal injury, mainly seen in gunshot wounds, knife wounds, explosive injuries, blows, and collisions that directly act on the spine, causing fractures or dislocations, and then damaging the spinal cord. The injury is consistent with the site of the external force, and the degree of injury is proportional to the size of the external force. It can occur at any part of the spinal cord, with the thoracic cord being the most common.

　　2. Closed injury

　　Mainly seen in traffic accidents, falls, sports-related sprains, spinal sprains, overloading, etc., causing excessive extension, flexion, and torsion of the spine, resulting in spinal fractures, dislocations, injuries to spinal appendages, or injuries to ligaments and spinal cord blood supply vessels, leading to closed injuries.

　　Open spinal cord defects may be associated with Aroold-Chiari malformation and hydrocephalus and other malformations. Open spinal cord defects may also complicate bedsores, urinary tract infections, joint stiffness and deformities, respiratory tract infections, and other conditions.

　　Clinical manifestations of open spinal cord defects

　　1. The mother of patients with open spinal cord defects had a history of infection, trauma, and medication during pregnancy.

　　2. It may be associated with Aroold-Chiari malformation and hydrocephalus and other malformations.

　　3. The local manifestations of open spinal cord defects include skin defects or cystic masses along the midline of the back, with a pulsating sensation, sometimes compressible. Compression on the anterior fontanelle may cause passive movement, and the root can be felt to have a defect in the spine. The surrounding area of the cyst bottom often has angioma-like skin and black hair.

　　4. Neurological symptoms may include lower limb sensory and motor disorders and autonomic nervous system dysfunction.

　　1. Maintain adequate nutrition, and the diet for spinal cord diseases should be rich in protein and vitamins, ensuring the intake of sufficient carbohydrates and trace elements.

　　2. Choose the correct diet according to your own condition, such as semi-solid, fluid, and semi-fluid foods, to prevent involvement of the medulla oblongata muscles.

　　3. Early-stage spinal cord disease patients should persist in work and carry out simple exercises, but should avoid overly intense activities and high-intensity exercises to prevent exacerbation of the condition.

　　4. Pay attention to personal hygiene, maintain good oral hygiene, and prevent food residue from remaining.

　　5. Cultivate personal interests in life, do more entertainment, and keep a cheerful mood; maintain sufficient sleep and ensure sleep quality to keep the spirit vigorous.

　　Spinal X-ray films can show spinal cord posterior fissure, midline bony septum, hemivertebrae, and narrowed intervertebral discs, etc. Spinal CT and MRI can clearly show the deformation of the spine and spinal cord.

　　Firstly, prefer eating

　　1. Prefer foods rich in calcium;

　　2. Prefer foods rich in protein;

　　3. Prefer foods rich in vitamin D.

　　Secondly, avoid eating

　　1. Avoid foods rich in carbonic acid;

　　2. Avoid foods that have a decalcifying effect;

　　3. Avoid eating acidic foods.

　　1. Purpose of Surgery

　　Remove the herniated sac, decompress the adhesions of the spinal cord and nerve roots, repair soft tissue defects, avoid cyst rupture, and prevent traction of neural tissue.

　　2. Timing of Surgery

　　The operation for spinal meningocele should be performed within 12-24 hours after birth; for simple meningocele, surgery should be performed 1-2 weeks after birth, and if conditions permit, it is safer to delay the operation to 2-3 months after birth; for those with thin cyst walls and a possibility of rupture and secondary infection, emergency surgery should be performed; if the cyst wall is eroded and there is infection or cerebrospinal fluid leakage, active infection control should be carried out, and surgery should be performed after the wound surface is clean or nearly healed.

　　3. Surgical Method

　　Take a prone position with the buttocks elevated and the head low to avoid losing too much CSF during surgery. For deformities at the lumbosacral region, a transverse ellipse incision is recommended to prevent contamination of the wound by urine and feces. The key points for handling during surgery are as follows:

　　1. Management of nerve tissue Incise at the junction of the base of the herniated sac and the normal skin, up to the paravertebral muscle fascia, to find the neck of the sac. Then, incise on the side of the neck to avoid injury to the nerve tissue located in the central part of the sac. Carefully dissect and decompress the spinal cord and spinal nerves, and bring them back into the spinal canal. If it is difficult to decompress or reposition, the upper endplate can be excised to expand the spinal bifida, so that the dissection and decompression is satisfactory.

　　2. Closure of the dura mater Determine the dura mater at the upper end of the lesion, divide towards both sides, and then suture the dura mater at the site of the lesion from top to bottom, freeing it from the paravertebral muscle fascia. Suture or tension-reducing suture the paravertebral muscles and their fascia to reinforce them.

　　3. Management of concurrent spinal deformity Perform laminectomy and metal wire fixation of the spine to treat spinal kyphosis and other deformities.

　　4. Repair of skin defects Remove transparent or thin-film-like skin, suture in two layers, and the suture should not be tense. It is only necessary to perform subfascial dissection at the fascial plane, and most skin defects can be sutured; when the skin defect exceeds half of the back, special skin flap transfer or free skin grafting treatment should be adopted.

　　4. Postoperative Management

　　After surgery, it is recommended to adopt a prone position with the head low to reduce the hydrostatic pressure of CSF on the repaired area. If there is a wound dehiscence or cerebrospinal fluid leakage, it is mostly due to progressive hydrocephalus, and external ventricular drainage or ventriculoperitoneal shunting should be performed.