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Dr. Mark
Dr. Mark, Doctor (MD)
Category: Health
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Experience:  U.S. Physician/Surgeon in Neurosurgery
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Need an answer from a neo-natal specialist or infant ortho

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need an answer from a neo-natal specialist or infant ortho spine specialist well versed in congenital kyphosis diagnosed via CT and MRI in 19 week fetus. It involves L2 and L3. Surgery or surgeries (number not known) is said to be the only treatment but no one will commit to the outcome of the surgery or surgeries.
This is my neice who is pregnant and they have been asked if they want to terminate the pregnancy. Since this was discussed, are these doctors indicating that the outcome at best is not good ? No one will give them the "real" prognosis here. They use words such as Manageable, treatable but what does that mean. Can someone spell it out here on what the reality will be for this child. No other complications are seen at this time. Can this get worse as pregnancy progesses ? The docs say they don't know.
L2 and L3 have no bone surrounding them and are seen in a "V" shape protruding outward from the spine . . . they are talking about fusing 4 vertebrae . . . someone needs to tell the real deal here so an informed decision can be made

Unfortunately, this is difficult situation here because no one really can predict the future, especially with a 19 week old fetus.

When they say that there is an issue with L2 and L3 and kyphosis -- it appears that the spine itself did not form correctly at this level, which can be an issue related to "spina bifida".

Unfortunately, at this time, it would be impossible to know if the nerves themselves were formed correctly, and if they would be functional below this level in the spine.

If the nerves did not function -- this would mean minimal movement in the hips, but no movement in the lower legs, leaving someone without the ability to walk, have sensation in the legs, or have bowel or bladder control. And that is an IF -- IF the nerves did not work below this area.

Surgeries can be done to "fuse" any abnormally formed bone -- but surgeries do not reverse nerve injuries, and that is what cannot be predicted. And they won't be able to predict what will happen as the pregnancy progresses.

So it is a tough decision, and one that can only be made after considering the risks and benefits and potential disability that this child may face during their lifetime.

Customer: replied 7 years ago.

they have been told that the bone did not form at L2 and L3 and that there is a protrusion in an outward "V" shape. They were told that they baby is moving around alot and kicking.

They were told that all other functions "appear" normal and that although there are no guarantees, it is unilkely that the current condition as they see it now would change.

They are to go back at 28 weeks which is a long way off and too late to terminate in Massacusetts as far as I understand.

If the baby is kicking, does that mean that there is nerve that has formed correctly ?

They were seen by a neurologist and by an orthopedic spine specialist but not the one who is the expert in the infant spinal fusion. This ortho spine specialist handles legs and feet as they relate to the the spine but presumbably this guy knows plenty about this condition. He is the one who asked them if they considered terminating the pregnancy . . . I think he was trying to send them a message as he was very non-commital in the remainder of the discussion about worst and best case scenarios. I know that u said that it is impossible to tell at 19 weeks.

Is it normal for a 19 week fetus to be moving to that degree or might the fetus be in some distress . . .

Well, the movement of the legs is a relatively good sign that the nerve function to at least some of the legs is intact, but it simply isn't possible to know if all the nerves are functioning.

And there are some issues with fusing the spine this early in life as well, as it can stunt the growth of the spinal segments that are fused.

I'm not an Obstetrician, but movement in a 19 week old fetus should be relatively normal.
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