Intraspinal pathology

The term "spinal dysraphism" covers two types of spinal congenital malformations, traditionally grouped as "open" and "closed" forms. These two groups have almost no features in common, including their embryological origin, presentation, natural history, and treatment algorithm. Open spinal dysraphism or myelomeningocele is primarily a neural tube closure defect, resulting with a more or less very stereotypic lesion and clinical presentation. The aim of treatment is to preserve the neurological and clinical status of the newborn. Closed spinal dysraphism is far more complicated and is represented by various forms of different combinations of mesodermal structures. While the neurological impairment in myelomeningocele is straightforward related to the incomplete differentiation of the neural tissue, the mechanisms of neurological impairment in closed dysraphisms are far more complex and controversial. This complexity, in turn, generates an ongoing controversy in establishing universal algorithms for treatment.