Spina bifida occulta at the lumbar spine level manifested as chronic low back pain and unpredictable neurologic deficit: A case report.

INTRODUCTION: Spina bifida occulta has a variety of symptoms that may hinder the diagnosis and subsequently delay appropriate treatment, causing a decrease in the patient's quality of life. This study aims to shed light on spina bifida occulta, with chronic low back pain as the predominant symptom, and the treatment applied in this case.

PRESENTATION OF CASE: A 46-year-old male was diagnosed with spina bifida occulta at the 5th lumbar spine after 2 years of having chronic low back pain that radiated to the left leg. He was initially diagnosed with chronic low back pain and was treated with epidural steroid injections which yielded a suboptimal outcome. Through an MRI examination, a spina bifida occulta at the 5th lumbar spine was identified and the patient was then referred to a tertiary hospital for further spinal decompressive treatments. The decompression level was obtained intraoperatively with the aid of intraoperative neurophysiological monitoring. Following the procedure, pain had almost completely subsided, and the patient regained full function for his daily activities without any pain or restrictions.

DISCUSSION: Non-specific clinical symptoms hindered the prompt diagnose of occult spinal dysraphism. MRI examinations of the spine is required and recommended for the characterization of intraspinal and perispinal abnormalities. Using intraoperative neurophysiological monitoring, we observed an improvement of nerve function at the L3-L5 level following decompression at the L3 level.

CONCLUSION: The diagnosis of spina bifida can be challenging when patients are presented with non-specific clinical symptoms, in this case as pain. We recommend spinal MRI examinations in cases of chronic lower back pain that fail to improve following expected pain management and therapy. Intraoperative neurophysiological monitoring can be used to assist in the identification of the level for decompression, as well as the resolution of pain.