Spinal Malformations

Spinal malformations include congenital conditions, such as cerebral palsy, muscular dystrophy and spina bifida as well as spinal arteriovenous malformations, arachnoid cysts, Chiari malformations and scoliosis.

WakeMed’s neurosurgeons and neurologists work in collaboration with other physicians, nurses, neuroradiologists and rehabilitation specialists to develop a personalized treatment plan for corrective approaches to these painful and, at times, debilitating conditions.

Symptoms of Spinal Malformations

Cerebral palsy usually will show the following symptoms:

• Movement and coordination problems, such as impaired muscle coordination and difficulty speaking
• Neurological disorders, such as urinary incontinence and problems with hearing and vision

Muscular dystrophy will typically involve the following telltale symptoms:

• Muscle weakness
• Difficulty walking, jumping, running or getting up
• Muscle pain and stiffness
• Toe walking

Spina bifida often exhibits with no symptoms. However, some people may experience the following:

• Abnormal hair and fat deposits in the spine
• Foot deformity
• Back, neck, shoulder or thigh pain
• Numbness and weakness in hands and legs; pain on back of legs
• Headache
• Weakness, numbness and/or tingling in arms and legs
• Stiffness in back, neck or thighs
• Difficulty balancing, walking or standing for long periods

Spinal arteriovenous malformations (AVM) have a range of symptoms from none at all to those that are life-threatening. Symptoms may include the following:

• Problems walking or climbing stairs
• Numbness, tingling and pain in legs or on the side(s) of the body
• Severe back pain
• Headache and/or light sensitivity
• Stiff neck
• Problems passing bowels or urinating

Arachnoid cysts are typically asymptomatic. However, they can cause some symptoms, including:

• Back pain
• Scoliosis
• Muscle weakness or spasms
• Numbness and tingling in your arms and legs
• Urinary and bowel incontinence

Chiari malformations come in three variations from type I to type III with type III being the most severe. As such, there can be a range of symptoms from none at all to complete debilitation.

• The following symptoms may manifest in types I and II:
• Speech problems and/or difficulty swallowing
• Dizziness and/or ringing in the ears o Problems with balance and fine motor skills
• Neck pain
• Numbness and/or tingling in the hands and feet
• Weakness, sometimes in the arms
• Curvature of the spine
• Sleep apnea or other breathing issues
• Type III is a congenital disorder and the most debilitating. It can lead to neurological symptoms and even death.

Scoliosis symptoms may be mild, but over time, symptoms may become more pronounced. They include:

• Back pain
• Uneven hips, waist or shoulders, or a protruding shoulder
• Leaning while standing

Types and Causes of Spinal Malformations

Often, spinal malformations are present at birth. However, there are many other possible causes.

Cerebral palsy is caused by a disturbance in brain development when a fetus is in utero or upon delivery.

Muscular dystrophy happens when there are changes in the genes that maintain the structure and function of muscle. These genes can be inherited or occur over the course of life.

Spina bifida is more prevalent in white and Hispanic people. It can also result from family history, folic acid deficiency, genetic defects, medications used during pregnancy or other medical conditions, such as diabetes.

The causes of spinal arteriovenous malformations are unknown.

Arachnoid cysts occur in the space between your brain or spinal column and your arachnoid membrane. They can result from spinal cord injury, complications from spinal surgery, meningitis and tumors.

Chiari malformations are structural defects resulting in brain tissue extending into the spinal cord. It happens when the skull is small or disfigured, forcing the brain downward. Complications include hydrocephalus, spinal bifida, syringomyelia or tethered cord syndrome.

Scoliosis is often a genetic disorder, but other risk factors include cerebral palsy, muscular dystrophy, birth defects in the spine, infections or injuries to the spine, tumors of the spine, uneven leg length, muscle spasms or inflammation.

Diagnosing Spinal Malformations

Neurological exams, physical exams, blood tests and imaging tests, including X-ray, computed tomography (CT) scan, nerve conduction studies (NCS), electromyography (EMG) and magnetic resonance imaging (MRI), may be taken. Tests help us visualize the internal structures in the back, including nerves, spinal cord, bones and soft tissues. You may also be given contrast dye to help the spinal canal show up better in the pictures, so alert your doctor if you’re allergic to contrast dye.

For congenital spinal malformations, ultrasounds and amniocentesis may be done in utero to detect these conditions.

Treating Spinal Malformations

Many patients can gain some control over their condition with self-care, medication and physical therapy.

Cerebral Palsy

• Self-care includes making the effort to be independent as much as possible.
• Medications include botox injections and muscle relaxants.
• Physical therapy is recommended along with occupational therapy, speech therapy and recreational therapy. We offer comprehensive physical therapy services in many convenient locations. Learn more about our rehab and physical therapy services.
• In some cases, orthopaedic surgery may be needed.

Muscular Dystrophy

• Self-care includes getting a pneumonia vaccine to prevent respiratory infections, eating healthy and attending medical appointments.
• Medications may include prednisone, creatine, acebutolol and atenolol.
• Physical therapy is recommended along with occupational therapy and exercise therapy. We offer comprehensive physical therapy services in many convenient locations. Learn more about our rehab and physical therapy services.

Spina Bifida

• Self-care involves keeping regular doctor’s appointments.
• Medications may ease pain. These include acetaminophen and ibuprofen.
• In more severe cases, surgery may be performed to prevent or reverse neurological issues that may result from tethered cord syndrome.

AVMs

Treatment varies greatly depending on the progression of disease and symptoms.

The goal of treatment is to reduce the risk of hemorrhage and prevent or stop advancing disability.

Arachnoid Cysts

We will initially monitor cysts for potential growth or changes. If necessary, we may surgically remove them or use fenestration or shunting to drain them.

Chiari Malformations

Surgery is the treatment of choice. These are the types of surgical procedures administered to reduce pressure on your cerebellum and spinal cord and restore normal spinal fluid flow:

• Posterior fossa decompression is used to remove a small section of the bone in the back of the skull to relieve pressure.
• The covering of the brain may be opened and a patch sewn in place to enlarge the covering.
• Part of the spinal column may be removed to relieve pressure on the spinal cord.
• A shunt may be put in place to drain excess fluid.

Scoliosis

Treatment begins with preventing progressive spinal curvature. Prevention methods include the following:

Physical and psychological therapies, such as regular exercise, participation in sports and involvement in social and support groups.

Self-care includes maintaining doctor’s appointments and wearing braces recommended by the doctor.

Once there is severe spinal curvature, surgery is recommended. Symptoms of severe progression involve the following:

• Impaired normal functioning of the heart and lungs
• Rotation or twisting of the spine
• Chronic back pain
• Increased space between the ribs and sides of the chest

Make an Appointment

We welcome new patients. If you’d like to meet with one of WakeMed’s neurological experts, please make an appointment by calling us at 919-350-7000.