Sacral Spina Bifida: Causes, Symptoms, and Management

Have you really been diagnosed with "occult spinal dysraphism of the first sacral vertebra"?

Hello, I recently received a health check report indicating that my "abdominal and lumbar sacral X-ray" results show "a latent spina bifida at the first sacral vertebra (a congenital change)," which was quite surprising to me.
I recall that when I was around 12 or 13 years old, I fell heavily on my buttocks in a stairwell, and at that time, I experienced severe pain at the base of my spine.
For several days after the fall, I felt sharp pain when using the restroom or when sitting down and touching my coccyx.
This condition persisted for several years, but the sharp pain gradually diminished over time, and the frequency decreased significantly.
I did not seek medical attention immediately after the fall, but around the age of 16, I underwent a few treatments at a rehabilitation department in the hospital (I only remember it involved some form of light therapy).
Now, approaching 30 years old, I only occasionally experience discomfort in my coccyx after prolonged sitting.
I also experience occasional lower back pain and have a habitual slouch, but I do not have any other significant abnormal sensations.

Therefore, I would like to ask if it is possible that my fall caused damage to my first sacral vertebra, rather than having a congenital latent spina bifida? Regardless of the cause, do I need to take any further actions or follow-ups? Will my sacral symptoms remain stable, or is there a possibility they could worsen? Are there any specific activities or precautions I should avoid or be aware of in my daily life? Thank you for your guidance!

Aris, 20~29 year old female. Ask Date: 2004/12/15

Dr. Xiao Furen reply Neurosurgery

It may still be necessary to review imaging studies to determine the exact issue.
Even if there has been a fall, it cannot be ruled out that there is a congenital problem.
Many patients with occult spinal dysraphism are asymptomatic.
Since there are no obvious symptoms, it is generally sufficient to be aware that there is an issue with the spine, without needing to investigate whether it is congenital or acquired, as there may not be a definitive answer.
General care includes minimizing heavy lifting and bending, and seeking medical attention promptly if new symptoms arise.

Reply Date: 2004/12/15

More Info

Understanding sacral spina bifida, particularly in the context of your recent findings regarding a "hidden spina bifida" at the first sacral vertebra (S1), can be quite complex. Spina bifida is a congenital condition where there is an incomplete closure of the neural tube, which can lead to various degrees of spinal cord and nerve root involvement. In your case, it appears to be a mild form, often referred to as spina bifida occulta, which is typically asymptomatic and may not require any specific treatment.

Causes of Sacral Spina Bifida
Spina bifida can occur due to a combination of genetic and environmental factors. The exact cause is often unknown, but it is believed that a deficiency in folic acid during pregnancy may contribute to the risk of neural tube defects. In your case, since the condition is described as "hidden" and congenital, it is likely that it was present from birth rather than resulting from your fall.

Symptoms
Many individuals with spina bifida occulta do not experience any symptoms. However, some may have mild symptoms related to nerve root irritation or compression, which can manifest as:
- Pain in the lower back or sacral area
- Numbness or tingling in the legs
- Weakness in the lower extremities
- Bladder or bowel dysfunction (in more severe cases)
In your situation, the pain you experienced after your fall at age 12-13 could be attributed to soft tissue injury or trauma to the coccyx (tailbone) rather than a direct result of the spina bifida. The fact that your symptoms have diminished over time is a positive sign.

Management and Follow-Up
Given that you are currently experiencing minimal discomfort and have not had significant issues, it may not be necessary to pursue aggressive treatment. However, it is essential to monitor your condition, especially if you begin to experience new or worsening symptoms. Here are some recommendations:
1. Regular Check-Ups: It would be prudent to have periodic evaluations with a healthcare provider, particularly a neurologist or orthopedic specialist, to monitor any changes in your condition.

2. Physical Therapy: Engaging in physical therapy can help strengthen the muscles around your spine and improve posture, which may alleviate some discomfort associated with prolonged sitting or poor posture.

3. Pain Management: If you experience pain, over-the-counter pain relievers such as ibuprofen or acetaminophen can be helpful. However, consult with your healthcare provider before starting any new medication.

4. Lifestyle Modifications: Pay attention to your posture, especially if you spend long periods sitting. Ergonomic chairs and regular breaks to stand and stretch can help reduce discomfort.

5. Avoid High-Impact Activities: While you may not need to avoid all physical activities, be cautious with high-impact sports or activities that could put excessive strain on your lower back.

6. Monitor Symptoms: Keep track of any changes in your symptoms, such as increased pain, numbness, or changes in bowel or bladder function, and report these to your healthcare provider promptly.

Conclusion
In summary, while your fall may have caused temporary pain and discomfort, it is unlikely to have caused the congenital condition of spina bifida occulta. Your current symptoms appear manageable, and with appropriate monitoring and lifestyle adjustments, you can maintain a good quality of life. Always consult with your healthcare provider for personalized advice and treatment options tailored to your specific situation.

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