Spina Bifida
Spina bifida, which literally means "cleft spine," is a neural birth defect in which there is an incomplete development of the spinal cord and vertebrae. This condition occurs after the first month of embryonic development, when the spinal cord normally closes. Infants with spina bifida are born with an open area in the spinal cord. This disorder is believed to be caused by a combination of genetic, nutritional and environmental factors.
Women who have given birth to one infant with spina bifida are more likely to give birth to another offspring with the disorder. Proper maternal nutrition, including an adequate amount of folic acid during pregnancy, can reduce the risk. There are several types of spina bifida that vary greatly in severity. Although the phrase spina bifida conjures images of extreme disability, only some types of this abnormality require treatment.
Types of Spina Bifida
There are four types of spina bifida, differentiated by the particular type of malformation involved and the presence or absence of certain symptoms:
- Spina Bifida Occulta
- Closed neural tube defects
- Meningocele
- Myelomeningocele
In occulta, or hidden, spina bifida, the mildest form of this disorder, a layer of skin covers the small opening in the vertebrae. Individuals may not even be aware that they have this malformation until it is discovered on a routine X-ray. Spina bifida occulta affects as much as 10 percent of the population. Patients have no neurological symptoms, though there may visible signs of this condition on the newborn's skin at the site of the abnormality, such as a birthmark, discoloration or unusual tuft of hair.
Closed neural tube defects and meningocele ( a rare type of this disorder) comprise several variations on spina bifida that may or may not cause serious difficulties, such as partial paralysis or bowel dysfunction.
Myelomeningocele is the most severe type of spina bifida. In this variation, also known as open spina bifida, the opening occurs along the length of several vertebrae in the middle or lower back. At birth, both the meninges and the spinal cord protrude on the infant's back, forming a sac. Although skin sometimes covers this sac, nerves and tissue are exposed. This is a highly dangerous condition, making the infant susceptible to infections, such as meningitis, which can be life-threatening.
Unfortunately, this form of spina bifida can affect almost all body systems. Babies born with myelomeningcele may experience partial or total paralysis that prevents walking and may result in weakness in the muscles of the upper body. They may also experience breathing and swallowing difficulties. Other symptoms of this disorder that may be evident at birth or show up as the baby grows may include:
- Orthopedic deformities, such as club foot or scoliosis
- Urinary and bowel incontinence
- Hydrocephalus
- Seizures
- Skin problems, especially allergy to latex
- Gastrointestinal problems
- Visual difficulties
- Learning problems
Not all of these symptoms are present in all patients.
Diagnosis of Spina Bifida
In many cases, spina bifida can be diagnosed while the fetus is still in utero through prenatal tests, including a fetal ultrasound, amniocentesis and tests of blood protein levels. After birth, X-rays and CT and MRI scans may be administered to detect particular spinal abnormalities or brain abnormalities, such as hydrocephalus.
Treatment of Spina Bifida
As noted, mild cases of spina bifida usually do not require any treatment. For more severe cases, fetal or postnatal surgery is often necessary to push the protruding regions of the spinal cord back into the vertebral column and closing the opening. Many specialists believe that the earlier surgery is performed, the better the patient outcome will be. If hydrocephalus is present, treatment with implantation of a shunt is necessary.
Some patients will require more than one surgery to deal with orthopedic problems of the feet, hips and spine. The higher up in the body the abnormality occurs, the more extensive the damage is likely to be. For some patients with severe spina bifida, supportive devices, like braces, crutches or wheelchairs, may be necessary for mobility. Concomitant conditions, such as visual, gastrointestinal, or skin problems, may have to be addressed by specialized treatments. With appropriate surgical and medical interventions, patients are able to lead productive, fulfilling lives.