Spina bifida: a multidisciplinary problem (a literature review)

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Abstract

BACKGROUND: Congenital malformations of the spine and spinal cord can be combined with various clinical manifestations of the spine, spinal cord, and lower extremities. Children with these neurological disorders often lack sensitivity and motor activity of their lower extremities and, in most cases, have bladder infections and incontinence (lack of bladder and bowel control).

AIM: This study aims to analyze publications with the diagnostic and treatment results of patients with neurological, orthopedic, neurological, and ophthalmological problems with spina bifida.

MATERIALS AND METHODS: We searched PubMed, Web of Science, Scopus, MEDLINE, eLibrary, and RSCI databases and found about 2000 references and 374 articles. We selected 60 articles for review in orthopedics, neurosurgery, urology, and ophthalmology.

RESULTS: Neural tube defects are a wide range of congenital malformations, including skull defects and open or closed spinal dysraphism. The incidence of spine and spinal cord malformations in different countries is quite broad and amounts to 0.3–199.4 cases per 10,000 births worldwide. Spinal cord malformations often occur in combination with bladder infections and incontinence, limb deformities, and other central nervous system developmental anomalies. Among the orthopedic problems leading to impaired support function, the most common are foot deformities and hip joint instability. Orthopedic monitoring of a patient with spina bifida consists of mainly preventing or correcting deformities according to the rehabilitation potential of the child. The timely completion of treatment allows the child to maintain mobility and independence of movement daily activities. At the same time, such treatment must pursue realistic goals according to the potential motor level of the child. In addition to neurosurgical and orthopedic problems, most children with spina bifida (88%–94%) suffer from pelvic disorders. A urologist should observe a patient with spina bifida to perform ultrasound and laboratory monitoring of both the lower and upper urinary tract conditions from an early age. Timely procedures to eliminate urinary retention and sanitation can maintain normal kidney function and contribute to the adequate conduct of motor and neurological rehabilitation of the child. The most common complication of spina bifida is the Chiari II malformation, which is manifested by damage to brain stem structures and internal occlusal hydrocephalus with various symptoms, including neuroophthalmological signs.

CONCLUSIONS: A multidisciplinary team of specialists comprising a neurologist, neurosurgeon, urologist, orthopedic surgeon, ophthalmologist, orthosis specialist, and psychologist should be involved in treating the children with the above presented problems. The use of an integrated approach to treat this group is absolutely justified and enabled the maximum rehabilitation potential of the child to be achieved.

About the authors

Stanislav V. Ivanov

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Author for correspondence.
Email: ortostas@mail.ru
ORCID iD: 0000-0002-2187-3973
SPIN-code: 1447-6213

Cand. Sci. (Med.)

Russian Federation, 64–68 Parkovaya str., Pushkin, St. Petersburg, 196603

Vladimir M. Kenis

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: kenis@mail.ru
ORCID iD: 0000-0002-7651-8485
SPIN-code: 5597-8832

Dr. Sci. (Med.)

Russian Federation, 64–68 Parkovaya str., Pushkin, St. Petersburg, 196603

Anna Y. Shchedrina

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery; Saint Petersburg State Pediatric Medical University

Email: annashchedrina@list.ru
ORCID iD: 0000-0002-6754-987X
SPIN-code: 7784-8024

urologist

Russian Federation, 64–68 Parkovaya str., Pushkin, Saint Petersburg, 196603; 2, st. Lithuanian, Saint Petersburg, 194100

Oleg N. Onufriichuk

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: oon@inbox.ru
SPIN-code: 1946-6731

Dr. Sci. (Med.), ophthalmologis

Russian Federation, 64–68 Parkovaya str., Pushkin, Saint Petersburg, 196603

Alina M. Khodorovskaya

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: alinamyh@gmail.com
ORCID iD: 0000-0002-2772-6747
SPIN-code: 3348-8038

scientific associate

Russian Federation, 64–68 Parkovaya str., Pushkin, St. Petersburg, 196603

Igor B. Osipov

Saint Petersburg State Pediatric Medical University

Email: osipovib@mail.ru
ORCID iD: 0000-0002-1170-3436
Russian Federation, 2, st. Lithuanian, Saint Petersburg, 194100

Sergei A. Sarychev

St. Petersburg State Pediatric Medical University

Email: serg_sarychev@mail.ru

Cand. Sci. (Med.), urologist

Russian Federation, 2, st. Lithuanian, Saint Petersburg, 194100

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