Spina Bifida

Spina bifida (literally “split spine”) is a general term for several different types of birth defects affecting the spine. It is one of the most common birth defects in the world and may lead to lifelong disability.

A healthy human embryo has a neural tube, which develops into a brain and spinal cord, usually around the 28th day. If the neural tube fails to develop properly or to close appropriately, the child is born with defects in the spinal cord and/or backbone. In some cases, a portion of the spinal cord will protrude from the body, and may be encased in a fluid-filled sac. Spina bifida may be associated with brain damage.

Causes

The cause of spina bifida is unknown. Genetic factors play a role in at least some forms of spina bifida. Dietary supplementation with folic acid during pregnancy is thought to help prevent the condition.

Terminology

There are four main types of spinal bifida:

  • Spina bifida occulta
  • Spina bifida cystica
  • Meningocele
  • Myelomeningocele

Spina bifida occulta is the least severe and may sometimes be asymptomatic. In patients with spina bifida cystica, a cyst prodtrudes through the vertebral arch. This condition may be associated with hydrocephalus or a buildup of excessive cerebrospinal fluid (CSF) in the skull. Meningocele, also known as meningeal cyst, is the least common form of spina bifida. In this condition, the vertebrae develop normally but the meninges or tissue layers that protect the central nervous system are displaced and may be forced into the gaps between the vertebrae. In patients with myelomeningocele, a portion of the spinal cord protrudes through the verterbral column and outside the body and is often enclosed by a meningeal membrane (fluid-filled protective sac). The protruding spinal cord and associated nerves are damaged and/or under-developed. Myelomeningocele is the most severe form of spina bifida.

Symptoms

In the mildest forms of spina bifida occulta, there may be mild or even no symptoms. Patients may go undiagnosed or be diagnosed when images are taken of the spine for other procedures. In more severe cases, spina bifida is evident in utero, at birth, or in early infancy.

Signs and symptoms include:

  • Hydrocephalus (sometimes called “water on the brain”)
  • Incontinence
  • Birth defect of the spine
  • Paraylsis
  • Neurological problems

Treatment

Some forms of spina bifida can be treated by paeditric neurosurgery, during which the spinal cord and nerves are placed back inside the spine and the opening in the back is surgically closed. A shunt or small tube may be implanted surgically to allow cerebrospinal fluid from the brain to drain harmlessly into the body, usually into the abdominal cavity. A shunt can reduce or prevent hydrocephalus.

If spina bifida is detected while a baby is in the womb, it may be possible to perform open fetal surgery.

Spina bifida patients require lifelong medical care including periodic check-ups by specialists to evaluate brain and nerve function, bones and muscle function, kidneys and bladder and other parts of the body. Paralysis is common in spina bifida patients but does not affect all. Depending on the level of the lession, patients may require urinary catheterization, splint, crutches, or a wheelchair for improved mobility.

Prognosis

Spina bifida cannot be cured, but it can be managed. The Neuro Spinal Hospital offers state-of-the-art care and treatment options for spina bifida patients, allowing for optimal outcomes. The prognosis of any individual spina bifida patient depends on the type of spina bifida, its severity, and how well it responds to treatment. Some spina bifida patients may have very minor symptoms, while others are profoundly disabled.

Risk Factors

Spina bifida is a birth defect and risk factors for pregnant women include:

  • Family history of neural tube defects
  • Folate deficiency (vitamin B-9 or folic acid)
  • Certain medications, including anti-seizure drugs
  • Diabetes, particularly with uncontrolled sugar levels
  • Obesity
  • Hyperthermia or higher-than-normal body temperature

Hyperthermia may occur when a person’s core body temperature is elevated by as few as 2 degrees Celsius above normal. This can happen as a result of fever but may also occur in persons who spend considerable time in saunas, tanning beds, or hot tubs. Evidence suggests that hyperthermia in the early months of pregnancy is associated with increased rates of spina bifida.

Conclusion

Spina bifida is a birth defect in which a portion of the spinal cord or its envelops may actually protrude from the veretebral column outside the body. Although some forms of spina bifida are not particularly severe, many forms are associated with lifelong disability. Some forms of spina bifida can be treated with paediatric surgery and lifelong management. When spina bifida is diagnosed while the baby is in the womb, an open fetal surgery may be performed. Spina bifida requires expert medical care from paediatric neurosurgeons familiar with the latest surgical techniques and treatments, such as the team at the Neuro Spinal Hospital.