The treatment of complex congenital neurosurgical pathologies affecting the spinal cord and spine requires the highest qualifications and an interdisciplinary approach.
Ichilov Medical Center, as one of the leading multidisciplinary medical centers, provides treatment for such conditions, including lumbar myelodysplasia. Here, thanks to the high qualifications of the doctors, advanced neuroimaging equipment, and innovative technologies, all possibilities for effective correction are available. A multidisciplinary team of specialists conducts progressive conservative and surgical therapy aimed at alleviating symptoms and improving prognosis. Special attention is given to individual comprehensive rehabilitation programs that help restore motor activity and ensure social adaptation.
About the Disease
Lumbar myelodysplasia is a group of congenital anomalies in which normal spinal cord formation in the lumbar region is disrupted during the intrauterine period. There are various types of disorders, affecting both the nerve fibers responsible for movement and sensation, as well as the nerve centers regulating the function of pelvic organs.
The following causes of the disorder are identified:
- maternal folic acid deficiency (one of the most significant factors);
- genetic features;
- exposure to toxic substances;
- use of certain medications;
- viral infections during the first trimester of pregnancy;
- significant hormonal or metabolic disorders;
- coexisting conditions in the pregnant woman (diabetes, obesity, vitamin and mineral deficiencies).
The most typical signs include:
- weakness in the legs;
- decreased muscle tone;
- sensitivity disorders (decreased or partial loss of sensation in the legs, numbness, decreased tactile sensations);
- deformities of the feet or spine;
- disruption of excretory functions (difficulty urinating and defecating);
- chronic pain in the lower back or lower limbs.
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Treatment Methods for the Disease
Treatment at Ichilov Medical Center is aimed at protecting the spinal cord from further damage, alleviating neurological symptoms, and preserving motor functions and normalizing the function of pelvic organs.
Surgical Correction of the Spinal Cord
In cases of significant spinal cord fixation and worsening neurological symptoms, surgery becomes necessary to prevent irreversible changes. Neurosurgeons use microsurgical techniques with high-resolution operating microscopes, allowing for delicate release of the spinal cord from pathological adhesions and relieving tension on nerve structures. Intraoperative neurophysiological monitoring tracks the functional activity of the spinal cord in real-time, minimizing the risk of damage. In children, surgery is often performed in several stages as they grow, to prevent re-fixation and maintain maximum mobility.
Removal of Terminal Filum Lipoma
When a fatty mass in the area of the cauda equina causes spinal cord fixation, its microsurgical excision restores normal mobility of the nerve structures. Under the guidance of navigation systems, the surgeon accurately locates the lipoma and removes it without affecting surrounding nerve roots. Endoscopic assistance through minimal incisions provides optimal visualization of deep sections of the spinal canal. After the lipoma is removed, the tension on the spinal cord disappears, halting the progression of neurological disorders and often leading to the restoration of lost functions in children at early stages.
Sectioning of the Thickened Terminal Filum
This method is used in cases of tethered spinal cord syndrome, where the terminal filum is abnormally short and thick. The operation involves precise transection of the fibrous cord that fixes the lower pole of the spinal cord to the sacrum. It is performed through a small incision at the lumbar level using microsurgical instruments. After sectioning, the spinal cord is able to move freely within the spinal canal when the body position changes, which is critically important for the growing child's body and prevents the development of scoliosis and other deformities.
Closure of Spinal Hernia
In the presence of a defect in the spine with protrusion of membranes and nerve tissue, reconstructive intervention is required in the first days of life. The neurosurgeon returns the contents of the hernial sac to the spinal canal, restores the integrity of the dura mater, and reinforces the defect with the patient's own tissues or biological implants. Plastic surgeons create a multilayer closure of the wound using skin-muscle flaps to prevent cerebrospinal fluid leakage. Early intervention reduces the risk of infectious complications and preserves maximum spinal cord functions.
Shunting for Hydrocephalus
Since myelodysplasia is often associated with impaired cerebrospinal fluid drainage, the installation of a ventriculoperitoneal shunt becomes vital. The neurosurgeon implants a thin silicone system that drains excess fluid from the brain's ventricles into the abdominal cavity, where it is naturally absorbed. Programmable valves with adjustable pressure allow for individual adjustment of the drainage rate under neuroimaging control. Modern shunting systems have anti-siphon devices and reservoirs for cerebrospinal fluid sampling for analysis, simplifying diagnosis in cases of suspected infection or dysfunction.
Physical Therapy and Rehabilitation
After the surgical phase or in mild forms without indications for surgery, comprehensive rehabilitation helps to maximize the development of preserved functions. Specialists create an individual program that includes therapeutic exercises to strengthen the back and lower limb muscles, massage to improve circulation and prevent contractures. Hydrotherapy in a pool reduces the load on the spine and allows for movement practice in a facilitated environment. Electrical stimulation of weakened muscles activates neuromuscular transmission, while training on robotic complexes forms the correct walking pattern in children with paresis.
Orthotics and Assistive Devices
For patients with persistent motor disorders, custom orthopedic devices are made to compensate for functional deficits. Ankle-foot orthoses prevent foot drop and provide stability while walking, while braces support the spine and slow the progression of deformities. Rehabilitation specialists select mobility aids ranging from walkers to wheelchairs based on the patient's level of independence. Regular adjustments to orthoses are necessary for children during growth to ensure that the devices match changing body parameters and do not restrict development.
Urological Support
Disruption of bladder innervation in myelodysplasia requires constant urological monitoring to prevent complications. Patients are taught the technique of clean intermittent catheterization, which prevents bladder overdistension and urinary tract infections. Urodynamic studies assess detrusor and sphincter function, allowing for timely medication adjustments with anticholinergic or adrenergic blocker medications. If conservative measures are ineffective, reconstructive surgeries to increase bladder capacity or create an artificial reservoir are performed, significantly improving quality of life.
Diagnostic Methods for the Disease
At Ichilov Medical Center, examinations using modern equipment and progressive laboratory techniques allow for an accurate diagnosis and treatment program to be established in an average of three days.
First Day
Upon arrival at the clinic, the patient attends a primary consultation with the attending physician. During the appointment, the specialist examines the patient, reviews existing medical reports, and orders additional examinations.
Second Day
Diagnostic examinations are conducted:
- visualization methods (CT, MRI, ultrasound of the kidneys and bladder);
- electromyography;
- nerve-stimulating tests (NST);
- laboratory blood and urine tests.
Third Day
The medical council reviews the obtained results, determines the final diagnosis, and collectively selects the most effective treatment methods.
- Computed Tomography
- Magnetic Resonance Imaging (MRI)
- Diagnosis — PET CT
What is the Cost of Treatment
The cost of treatment in Israel is significantly lower than in many countries leading in medical tourism. The final cost is calculated after the therapy is completed, but approximate rates can be obtained from the clinic's consultant.
Advantages of Treatment in Israel
- High level of physician training.
- Modern equipment in medical centers.
- Application of progressive therapeutic and diagnostic methods.
- Development of an individual therapy program.
- Affordable prices.
Foreign patients can have an online consultation with an Israeli doctor while staying at home. They should contact the clinic's consultant, request a consultation, and connect at the agreed time. The specialist will evaluate the provided medical documents and recommend further actions.