Spina bifida differential diagnosis: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Spina_bifida]] | |||
{{CMG}}; {{AE}}{{MMJ}} | {{CMG}}; {{AE}}{{MMJ}} | ||
==Overview== | ==Overview== | ||
:Spina bifida must be differentiated from other diseases that causes [[vertebral column]] defects, spinal deformity and [[neurologic]] abnormalities or [[gait]] abnormalities, such as: Terminal myelocystocele, spine segmental [[dysgenesis]], [[Caudal regression syndrome]] ([[sacral agenesis]]), multiple [[vertebral]] segmentation disorder, [[VACTERL|VACTERL association,]] [[Arnold-Chiari malformation|arnold-chiari malformation]], [[syringomyelia]], [[Scoliosis]], and [[leg length discrepancy]]. | |||
==Differentiating | ==Differentiating spina bifida from other Diseases== | ||
*Spina bifida must be differentiated from other diseases that | *Spina bifida must be differentiated from other diseases that causes [[vertebral column]] defects, spinal deformity and [[neurologic]] abnormalities or [[gait]] abnormalities, such as: Terminal myelocystocele, spine segmental [[dysgenesis]], [[Caudal regression syndrome]] ([[sacral agenesis]]), multiple [[vertebral]] segmentation disorder, [[VACTERL|VACTERL association,]] [[Arnold-Chiari malformation|arnold-chiari malformation]], [[syringomyelia]], [[Scoliosis]], and [[leg length discrepancy]].<ref name="pmid28786774">{{cite journal| author=Calloni SF, Huisman TA, Poretti A, Soares BP| title=Back pain and scoliosis in children: When to image, what to consider. | journal=Neuroradiol J | year= 2017 | volume= 30 | issue= 5 | pages= 393-404 | pmid=28786774 | doi=10.1177/1971400917697503 | pmc=5602330 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28786774 }} </ref><ref>Azar, F., Canale, S., Beaty, J. & Campbell, W. (2017). Campbell's operative orthopaedics. Philadelphia, PA: Elsevier. Page: 1898-2028.</ref><ref name="pmid9514174">{{cite journal |vauthors=Meyer SH, Morris GF, Pretorius DH, James HE |title=Terminal myelocystocele: important differential diagnosis in the prenatal assessment of spina bifida |journal=J Ultrasound Med |volume=17 |issue=3 |pages=193–7 |date=March 1998 |pmid=9514174 |doi= |url=}}</ref><ref name="pmid3374785">{{cite journal |vauthors=Scott RM, Wolpert SM, Bartoshesky LE, Zimbler S, Karlin L |title=Segmental spinal dysgenesis |journal=Neurosurgery |volume=22 |issue=4 |pages=739–44 |date=April 1988 |pmid=3374785 |doi= |url=}}</ref><ref name="pmid4925436">{{cite journal |vauthors=Kremser E, Mitchell GM |title=Treatment of primary dysmenorrhea with a combined type oral contraceptive--a double blind study |journal=J Am Coll Health Assoc |volume=19 |issue=3 |pages=195–6 |date=February 1971 |pmid=4925436 |doi= |url=}}</ref><ref name="pmid5991006">{{cite journal |vauthors=Benedetti-Valentino F J, De Feo V, Pistolese GR, Fiorani P |title=[Nephroptosis and fibromuscular hyperplasia of the tunica media of the renal arteries] |language=Italian |journal=Minerva Cardioangiol |volume=14 |issue=9 |pages=528–34 |date=September 1966 |pmid=5991006 |doi= |url=}}</ref><ref name="pmid3169446">{{cite journal |vauthors=Naccarato R, Sturniolo GC, Martin A, D'Odorico A, Montino C |title=[Irritable bowel syndrome] |language=Italian |journal=G Clin Med |volume=69 |issue=3 |pages=163–8 |date=March 1988 |pmid=3169446 |doi= |url=}}</ref> | ||
{| | {| | ||
|- style="background: #4479BA; color: #FFFFFF; text-align: center;" | |- style="background: #4479BA; color: #FFFFFF; text-align: center;" | ||
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases | ! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases | ||
| colspan=" | | colspan="3" |'''Clinical manifestations''' | ||
! colspan="2" rowspan="2" |Para-clinical findings | ! colspan="2" rowspan="2" |Para-clinical findings | ||
| colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard''' | | colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard''' | ||
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Additional findings | ! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Additional findings | ||
|- | |- | ||
! colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical examination | ! colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical examination | ||
|- | |- | ||
! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging | ! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging | ||
|- | |- | ||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" | | ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Vertebra column defect | ||
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" | | ! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Protrusions, Dimples, Hair patch in the spine | ||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Motor and sensory abnormalities | ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Motor and sensory abnormalities | ||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |X-ray | ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |X-ray | ||
(PA and Lateral view) | (PA and Lateral view) | ||
Line 40: | Line 29: | ||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Spina bifida]] | | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Spina bifida]] | ||
| style="background: #F5F5F5; padding: 5px;" | + | | style="background: #F5F5F5; padding: 5px;" | ++ | ||
| style="background: #F5F5F5; padding: 5px;" | + | | style="background: #F5F5F5; padding: 5px;" | ++ | ||
| style="background: #F5F5F5; padding: 5px;" | +/- | | style="background: #F5F5F5; padding: 5px;" | +/- | ||
| style="background: #F5F5F5; padding: 5px;" |Incomplete union of the posterior elements of [[Vertebra|vertebral]] levels | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* Various degrees of failure of [[Neural tube defect|neural tube]] closure | |||
* Posterior sac contains [[meninges]] and/or [[spinal cord]] | |||
| style="background: #F5F5F5; padding: 5px;" |[[MRI]] | |||
| style="background: #F5F5F5; padding: 5px;" | - | |||
|- | |||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Terminal myelocystocele | |||
| style="background: #F5F5F5; padding: 5px;" | +/- | | style="background: #F5F5F5; padding: 5px;" | +/- | ||
| style="background: #F5F5F5; padding: 5px;" | Protrusions and dimples | |||
| style="background: #F5F5F5; padding: 5px;" | +/- | | style="background: #F5F5F5; padding: 5px;" | +/- | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |Incomplete union of the posterior elements of [[Vertebra|vertebral]] levels | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Various degrees of failure of [[Neural tube defect|neural tube]] closure | * Various degrees of failure of [[Neural tube defect|neural tube]] closure | ||
Line 53: | Line 49: | ||
| style="background: #F5F5F5; padding: 5px;" |[[MRI]] | | style="background: #F5F5F5; padding: 5px;" |[[MRI]] | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* [[ | * Progression of lower extremity paralysis | ||
* | * Common in patients with [[cloacal exstrophy]] | ||
* | |||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" | | | style="background: #DCDCDC; padding: 5px; text-align: center;" |Spine segmental dysgenesis | ||
| style="background: #F5F5F5; padding: 5px;" | + | |||
| style="background: #F5F5F5; padding: 5px;" | - | |||
| style="background: #F5F5F5; padding: 5px;" | +/- | | style="background: #F5F5F5; padding: 5px;" | +/- | ||
| style="background: #F5F5F5; padding: 5px;" |Defects in the segments of the spine and spinal cord | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* Spinal cord at the level of the abnormality is thinned or even indiscernible | |||
* a bulky, low-lying cord segment may be present caudad to the focal abnormality in most cases | |||
| style="background: #F5F5F5; padding: 5px;" |[[MRI]] | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* The spinal column distal to the abnormality may be partially bifid | |||
* | |||
|- | |||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Caudal regression syndrome]] ([[sacral agenesis]]) | |||
| style="background: #F5F5F5; padding: 5px;" | + | | style="background: #F5F5F5; padding: 5px;" | + | ||
| style="background: #F5F5F5; padding: 5px;" | +/- | |||
| style="background: #F5F5F5; padding: 5px;" | +/- | |||
| style="background: #F5F5F5; padding: 5px;" |Agenesis of the sacrum and lumbar spine | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* Lumbosacral vertebral body dysgenesis/hypogenesis | |||
* The level of atresia/dysgenesis is usually below L1 and often limited to sacrum | |||
| style="background: #F5F5F5; padding: 5px;" |[[MRI]] | |||
| style="background: #F5F5F5; padding: 5px;" |Associated with other developmental malformations (orthopedic, neurological, genito-urinary, gastrointestinal…) | |||
* | |||
|- | |||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[VACTERL|VACTERL association]] | |||
| style="background: #F5F5F5; padding: 5px;" | + | | style="background: #F5F5F5; padding: 5px;" | + | ||
| style="background: #F5F5F5; padding: 5px;" | +/- | |||
| style="background: #F5F5F5; padding: 5px;" | +/- | |||
| style="background: #F5F5F5; padding: 5px;" |Vertebral body dysgenesis/hypogenesis | |||
| style="background: #F5F5F5; padding: 5px;" | - | |||
| style="background: #F5F5F5; padding: 5px;" |[[MRI]], Ct scan, X ray | |||
| style="background: #F5F5F5; padding: 5px;" |[[VACTERL association|VACTERL]] stands for: | |||
* Vertebral defects | |||
* [[Anal atresia]] | |||
* Cardiac defects | |||
* Tracheo-Esophageal fistula | |||
* Renal anomalies | |||
* Limb abnormalities | |||
* | |||
|- | |||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Arnold-Chiari malformation|Arnold-chiari malformation]] | |||
| style="background: #F5F5F5; padding: 5px;" | + | | style="background: #F5F5F5; padding: 5px;" | + | ||
| style="background: #F5F5F5; padding: 5px;" | + | | style="background: #F5F5F5; padding: 5px;" | + | ||
Line 74: | Line 112: | ||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Syringomyelia]] | | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Syringomyelia]] | ||
| style="background: #F5F5F5; padding: 5px;" | + | | style="background: #F5F5F5; padding: 5px;" | + | ||
| style="background: #F5F5F5; padding: 5px;" | + | | style="background: #F5F5F5; padding: 5px;" | + | ||
Line 90: | Line 125: | ||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Scoliosis]] | | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Scoliosis]] | ||
| style="background: #F5F5F5; padding: 5px;" | +/- | | style="background: #F5F5F5; padding: 5px;" | +/- | ||
| style="background: #F5F5F5; padding: 5px;" | +/- | | style="background: #F5F5F5; padding: 5px;" | +/- | ||
Line 106: | Line 138: | ||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Leg length discrepancy]] | | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Leg length discrepancy]] | ||
| style="background: #F5F5F5; padding: 5px;" | - | | style="background: #F5F5F5; padding: 5px;" | - | ||
| style="background: #F5F5F5; padding: 5px;" | - | | style="background: #F5F5F5; padding: 5px;" | - |
Latest revision as of 17:01, 13 March 2019
![](/images/1/16/Home_logo1.png)
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]
Overview
- Spina bifida must be differentiated from other diseases that causes vertebral column defects, spinal deformity and neurologic abnormalities or gait abnormalities, such as: Terminal myelocystocele, spine segmental dysgenesis, Caudal regression syndrome (sacral agenesis), multiple vertebral segmentation disorder, VACTERL association, arnold-chiari malformation, syringomyelia, Scoliosis, and leg length discrepancy.
Differentiating spina bifida from other Diseases
- Spina bifida must be differentiated from other diseases that causes vertebral column defects, spinal deformity and neurologic abnormalities or gait abnormalities, such as: Terminal myelocystocele, spine segmental dysgenesis, Caudal regression syndrome (sacral agenesis), multiple vertebral segmentation disorder, VACTERL association, arnold-chiari malformation, syringomyelia, Scoliosis, and leg length discrepancy.[1][2][3][4][5][6][7]
Diseases | Clinical manifestations | Para-clinical findings | Gold standard | Additional findings | |||
---|---|---|---|---|---|---|---|
Physical examination | |||||||
Imaging | |||||||
Vertebra column defect | Protrusions, Dimples, Hair patch in the spine | Motor and sensory abnormalities | X-ray
(PA and Lateral view) |
M.R.I. | |||
Spina bifida | ++ | ++ | +/- | Incomplete union of the posterior elements of vertebral levels |
|
MRI | - |
Terminal myelocystocele | +/- | Protrusions and dimples | +/- | Incomplete union of the posterior elements of vertebral levels |
|
MRI |
|
Spine segmental dysgenesis | + | - | +/- | Defects in the segments of the spine and spinal cord |
|
MRI |
|
Caudal regression syndrome (sacral agenesis) | + | +/- | +/- | Agenesis of the sacrum and lumbar spine |
|
MRI | Associated with other developmental malformations (orthopedic, neurological, genito-urinary, gastrointestinal…)
|
VACTERL association | + | +/- | +/- | Vertebral body dysgenesis/hypogenesis | - | MRI, Ct scan, X ray | VACTERL stands for:
|
Arnold-chiari malformation | + | + | + | None | MRI |
| |
Syringomyelia | + | + | + |
|
MRI |
| |
Scoliosis | +/- | +/- | +/- |
|
MRI |
| |
Leg length discrepancy | - | - | - |
|
None | Orthoroentogram |
References
- ↑ Calloni SF, Huisman TA, Poretti A, Soares BP (2017). "Back pain and scoliosis in children: When to image, what to consider". Neuroradiol J. 30 (5): 393–404. doi:10.1177/1971400917697503. PMC 5602330. PMID 28786774.
- ↑ Azar, F., Canale, S., Beaty, J. & Campbell, W. (2017). Campbell's operative orthopaedics. Philadelphia, PA: Elsevier. Page: 1898-2028.
- ↑ Meyer SH, Morris GF, Pretorius DH, James HE (March 1998). "Terminal myelocystocele: important differential diagnosis in the prenatal assessment of spina bifida". J Ultrasound Med. 17 (3): 193–7. PMID 9514174.
- ↑ Scott RM, Wolpert SM, Bartoshesky LE, Zimbler S, Karlin L (April 1988). "Segmental spinal dysgenesis". Neurosurgery. 22 (4): 739–44. PMID 3374785.
- ↑ Kremser E, Mitchell GM (February 1971). "Treatment of primary dysmenorrhea with a combined type oral contraceptive--a double blind study". J Am Coll Health Assoc. 19 (3): 195–6. PMID 4925436.
- ↑ Benedetti-Valentino F J, De Feo V, Pistolese GR, Fiorani P (September 1966). "[Nephroptosis and fibromuscular hyperplasia of the tunica media of the renal arteries]". Minerva Cardioangiol (in Italian). 14 (9): 528–34. PMID 5991006. Vancouver style error: name (help)
- ↑ Naccarato R, Sturniolo GC, Martin A, D'Odorico A, Montino C (March 1988). "[Irritable bowel syndrome]". G Clin Med (in Italian). 69 (3): 163–8. PMID 3169446.