Spinal Cord Injury

Dr. Fred Carroll

Dr. Fred Carroll

Spina Bifida is a birth defect caused by an incorrect closure of the central neural tube during the early stages of pregnancy. The defect can occur along the entire central nervous system or only part of it.

The reasons for the defect are not clear, but it is known that there are both genetic and environmental components.

On a visit to the multidisciplinary Spina Bifida clinic, the patient will pass through several “stations”. At the end of the day, the treatment team will meet and agree upon recommendations for the individual based on the information gathered throughout the visit.

preliminary treatment

Since the defect occurred in-utero and causes damage to the newborn's extremities, treatment should be started as close to birth as possible. It is advisable for a physiotherapist to begin stretching the limbs to prevent shortening of the soft tissues surrounding the joints as well as parental guidance to ensure the best possible outcomes. Despite this, it is important to know that even intensive therapy may not prevent the formation of contractions and/or skeletal deformities in some children, and that in the future they may require surgical treatment.

Since the damage to the spine/spinal cord is extensive and also includes damage to the roots, usually paralysis of the lower extremities will be accompanied by weak muscle tone. It is recommended that these children receive physiotherapy for the first year of life. As soon as they reach the age of one year, when they are expected to spend more time in a vertical position, they will need back support with a corset. This corset will allow for more stability while sitting and assistance in maintaining better balance.

One of the complications in these children is the development of scoliosis, and the use of a corset may reduce this risk. Towards the age of one year, it is advisable to try placing the child in a “supine stander”. In the first few years of life it is advisable to adjust devices in order to practice walking.

Children with complete paraplegia can also be taught how to walk using a treadmill. Achieving the ability to walk does not necessarily guarantee that it will endure.


Spinal deformities with other complex diseases

Spinal deformities in children with other complex diseases require a different therapeutic approach than used in children with deformities who do not have other comorbidities. In this complex population, spinal deformities can start at a very young age, progress at a faster rate and become severe and even life-threatening. Treatment with corsets is different and more complex, and often inadequate when treating scoliosis: the goal is to postpone surgical intervention until an older age when it will be preferable to perform the surgery. All of these services are provided as part of the consultation in our clinics.

After a surgery to repair the spinal deformity, we generally recommend full hospitalization in the rehabilitation department, at least until the pain has subsided. There we can help practice breathing and transitioning while allowing the family to get set up at home with the assistive equipment required for the recovery period. After a brief inpatient period, and according to the instructions given by the surgeon, we will be able to plan the duration of hospitalization and the best framework for you during the lengthy rehabilitation (full hospitalization, outpatient/partial hospitalization, educational setting, etc).


Spinal Cord Injury

Seating adaptations are recommended 6 weeks post-surgery, not immediately.

other common disease in children suffering from spina bifida is:

Tethered cord: Spinal cord “fixation” often develops in the area of the spine/spinal cord. The typical signs of this fixation development are changes in the muscle tone of the legs, development of galloping scoliosis, changes in bladder activity and more. Exacerbation of symptoms is common during periods of accelerated growth, especially in adolescence. The fixation is treated with surgery. Recurrence of fixation may happen even after full "release", especially when there is a lipoma in the affected area.

Syrinx: Formation of a large amount of fluid within the spinal cord causes internal pressure on the spinal cord. Signs of the development of syrinx include weakness and a change in sensation. 

Pressure wounds: Due to the numbness of the dermatomes distal to the back injury, these children are prone to develop pressure ulcers or burns.

Growth: Most children with spina bifida have low stature. The limited growth can also be linked to the formation of contractures in the joints and a high incidence of hip joint dislocation and the development of scoliosis (or congenital scoliosis). In addition, there is a high tendency for obesity, especially in children whose walking is very limited and most of their mobility is done via wheelchair.

Scoliosis and kyphosis: Some children with spina bifida will at some point need orthopedic surgical intervention due to severe kyphosis or severe scoliosis.