Neuro Spine Care

Back and neck pain are common complaints. Overexertion, minor trauma and a child’s day-to-day activities are the most common causes of back and neck pain.

Call a doctor right away if your child has any of the following symptoms:

• Pain radiating down the arm or leg
• Weakness or numbness
• Change in bowel or bladder function
• Pain that does not improve or worsens when lying flat
• Worsening pain

Our specialists work together to determine the best treatment path for each child. Rest, over-the-counter pain relievers and time usually help resolve neck and back issues within a few days. If pain continues, a doctor might suggest additional medication or tests.

Chronic (constant) pain from a variety of neurological and musculoskeletal conditions can affect the daily lives of children and teens.

Treatment may include medication, physical therapy, therapeutic injections or surgery. Your child’s doctor will help determine the best treatment path for your child. Some spine procedures might reduce or eliminate the pain pathway, which can improve a child’s quality of life.

Congenital spinal disorders are present at birth but can often be treated with surgery. Congenital syndromes with spinal disorders include:

• Down syndrome
• Klippel-Feil syndrome—fusion of any two vertebrae in the neck
• Achondroplasia—a common form of dwarfism

Some spinal disorders happen at the craniocervical junction, a complex area where the skull and upper cervical spine join together. The connection between the brain and spinal cord is at the base of the brainstem in the craniocervical junction region. Craniocervical junction disorders can weaken the spine and cause neurological injuries.

Encephalocele is an open neural tube defect (NTD) that is most often present at birth. Normally, the neural tube folds and closes to form the brain and spinal cord around the third or fourth week of pregnancy, before most women even know they are pregnant.

Encephalocele happens when the tube does not fully close during pregnancy. This causes the brain, and the membranes that cover it, to poke out through openings in the skull. The Centers for Disease Control and Prevention (CDC) reports that each year that about 375, or 1 in every 10,000 babies born in the U.S., will have encephalocele.

In recent years, disc herniation in children has become more common. A herniated disc develops when one of the discs between the bones (vertebrae) of the spine moves out of position and presses on adjacent nerves. These discs are cushions that have a soft center and hard outside. If the hard part of the disc cracks and the soft part is exposed, it is called a hernia. A herniated disc can also be called a pinched nerve or bulging disc.

Scoliosis is a sideways curve of the spine. The curve can make the spine look like an “s” or a “c” rather than a straight line when viewed from the back. Scoliosis is defined as a curve of 11 degrees or greater and can be mild, moderate or severe.

Although scoliosis can develop at any age, it usually starts during adolescence, when most children are growing rapidly.

As the spine grows, it bends to the side and may twist or rotate. Since the ribs are attached to the vertebrae, the chest wall can rotate and make the ribs and chest look uneven. This twisting can also make the shoulders or waist look uneven.

A tumor can grow in the bones of the spine or in the spinal cord. Tumors of the spine and spinal cord can be cancerous (malignant) or noncancerous (benign). Symptoms include:

• Back pain—often at night while in bed
• Neurological deficits
• Arm or leg pain

Our doctors will determine the best treatment path for each child’s cancerous or noncancerous tumors. Our surgeons can remove some tumors during surgery. In other cases, medical treatment after surgery might also be necessary.

Children with some conditions are more likely to develop spinal cord tumors. However, the majority of tumors happen in otherwise healthy children.

Spinal degeneration happens when discs in the spine break down over time. Symptoms include:

• Back or neck pain
• Arm or leg pain
• Pain that gets worse with movements like bending or twisting

Treatment options for spinal degeneration include medication, physical or occupational therapies, and minimally invasive surgery. Your child’s doctor will help determine the best treatment plan. Some spine procedures can reduce or eliminate the pain pathway, which may improve your child’s quality of life.

Myelodysplasia is one type of neural tube defect (NTD). In a child born with myelodysplasia, there is an open defect on the back. The neural plate fails to become rounded, and the backbone, muscles and skin fail to take their proper place over the spinal cord.

Around the third week of pregnancy, a line of cells called the neural plate appear on the back of the embryo. The neural plate will become the brain and the spinal cord. Around the fourth week of pregnancy, the neural plate changes shape. It becomes rounded into a tube called the neural tube. As it changes from a flat to a rounded shape, the neural tube is covered with tissue. This tissue will become the backbone, muscle, fat and skin. An NTD like myelodysplasia occurs when the neural tube or its overlying tissue doesn’t develop properly.

Injuries to the spine range from a simple muscle strain to paralysis. Trauma can sometimes cause immediate problems with a child’s spine. Problems like instability, scoliosis, kyphosis and chronic pain can develop years after the original injury.

At Children’s, our team is dedicated to helping patients with spinal cord injuries. Treatment options range from surgery and pain management to rehabilitation.

Spondylolisthesis is a condition in which one vertebra is out of place. The most common form of spondylolisthesis in children is isthmic spondylolisthesis, which is often called pars defect. A birth defect or trauma—most commonly a stress fracture—can cause this to happen.

Symptoms include:

• Low back pain
• Progressive instability of the spinal column
• Spinal cord compression
• Muscle spasms in the back of the thighs

Most patients who receive medication, physical therapy and doctor’s supervision will improve without requiring surgery. In most cases, there is no reason to limit activities during this period.

If surgery is recommended, surgeons might remove a part of the vertebra, realign the spine and fuse it. This relieves pressure on the nerves or spinal cord and helps correct deformities. Surgery is performed only on patients whose symptoms continue to worsen.

A tethered spinal cord occurs when the lower part of the spinal cord attaches to the meninges (the membrane around the cord). This keeps the cord from being able to move freely. As a child grows and moves around, the spinal cord gets stretched and pulled, and this can cause problems with pain and movement.

A tethered spinal cord is often seen in patients who have spina bifida. Children with spina bifida often have some tethering but may not need treatment unless they have symptoms. Other causes may include injury or infection to the spine, spinal surgery, or a tumor on the spine.