Question
An 11-year-old child occasionally has nocturnal enuresis. An X-ray examination reveals a spinal dysraphism at the sacral vertebrae 1-4, walks with an in-toe gait, and has previously experienced symptoms of lower limb weakness, unable to walk. The child is inquiring about the treatment methods for spinal dysraphism.
Answer
Congenital cryptic spinal dysraphism involves a gap in the lumbar and sacral vertebrae, with the cauda equina and dura mater protruding through the gap, causing adhesion and fixation. When symptoms such as frequent urination, urgency, incontinence, constipation, fecal incontinence, muscle atrophy of the gastrocnemius, high arches, and clubfoot occur due to traction, tension, ischemia, and produce many symptoms like sacral cord vagal nerve center and cauda equina, surgical separation of adhesions is required to cut the filum terminale, release the cauda equina, and restore sacral cord blood supply. If the condition is mild, such as nocturnal enuresis alone, conservative treatment can be considered, and treatment may not be necessary temporarily. If the condition is severe, such as incontinence of urine and feces, surgical treatment is certainly required, and the sooner the surgery is performed, the better the outcome. Consultation with a pediatric neurosurgery specialist is recommended.