The child's lumbar sacral vertebra is fractured

Almost everyone knows that a child's early body structure is very fragile. Some problems are prone to occur, and now some problems have occurred that cannot be changed. Some children often have lumbar sacral cracks due to congenital developmental abnormalities. Generally speaking, lumbar sacral cracks will not cause low back pain, but it will have a great impact on the child's normal life. So what should we do after discovering that the child's lumbar sacral cracks have occurred?

1. Physiological and pathological manifestations:

Nonunion of the first sacral and fifth lumbar vertebral arches is the most common congenital anomaly of the lumbar vertebrae. The incidence of lumbar spinal cord fissure varies from one statistical agency to another. Southworth et al. found hidden fissures in 18.6% of 550 asymptomatic lumbar X-rays, while GROW et al. found hidden fissures in 35.7%. Guo Shifu observed 400 sacral specimens and found that 28.7% of S1 and S2 had hidden fissures. The Affiliated Hospital of Qingdao Medical College counted lumbar X-rays of 800 patients with general low back pain and found 123 cases of sacral fissures and 6 cases of unhealed vertebral arches! There were 6 cases of L5S1 cleft, out of a total of 135 cases, accounting for 16.8%. In the lumbar X-ray films of 100 college students without low back pain, the incidence of sacral fissure was 24%. Another statistics showed that among 200 patients with intervertebral disc herniation and sacral fissure, the incidence was 18.5%.

Generally, hidden fissures will not cause low back pain, but those with severe hidden fissures have weak local structures and are prone to chronic low back pain due to strain. Those with sacral fissures accompanied by free spinous processes can have their spinous processes stimulate the dura mater when bending over, causing low back pain. KITTRICH believes that the fibrous fat masses on the surface of the dura mater at the hidden fissure can compress the dura mater and nerve roots to cause low back pain and reduce or eliminate the knee-heel reflex. When the sacral fissure is accompanied by hypertrophy of the L5 spinous process, stretching the waist can stimulate the fibrous membrane between the fissures or the defective vertebral lamina stumps to cause pain. When adhesions form between the fibrous membrane and the dura mater or nerves, it can cause radiating pain to the lower limbs. GILLLESPE statistics showed that among 500 patients who underwent laminectomy, 18.2% had occult fissures, while only 4.8% had occult fissures among patients without lumbar spine. Shi Keren reported 46 cases of occult spina bifida, 15 of which presented with sciatica. Surgery confirmed that 8 of them had concomitant intervertebral disc herniation, with the herniation level at the upper space.

Therefore, for patients with clinically occult spina bifida accompanied by obvious sciatica, the nature of the occult spina bifida should be carefully analyzed as well as the symptoms and signs. For example, if there are obvious nerve root localization signs, the transitional vertebrae in the lumbosacral region may manifest as sacralization of the lumbar vertebrae or lumbarization of the sacral vertebrae. The transitional vertebrae are one of the causes of intermittent low back pain.

2. Disease diagnosis:

Spine X-rays, CT and MRI scans show spinal canal deformities, spinous process and lamina defects, which help in the diagnosis of the disease.

3. Treatment methods:

Generally speaking, no treatment is needed.

Protection: Avoid sitting or standing for long periods of time, bending over to carry weight for long periods of time, strenuous exercise, or trauma to the waist, and keep local warmth, etc.