Spina Bifida

Spina bifida (SB) happens when a baby is in the womb. Normally, the developing spinal column starts as an open tube and over time, this tube closes. In SB, the tube does not close all the way during the first month of pregnancy.

There are 4 different types of SB:

  • Spina bifida occulta. This is also called "hidden spina bifida" because there are no physical signs. About 15% of healthy people have it and do not know it. Spina bifida occulta does not cause harm. The spinal cord and nerves are fine. People usually find out they have it after having an X-ray of their back.

  • Occult spinal dysraphism (OSD). Babies with OSD have a dimple in their lower back. Because most babies with dimples do not have OSD, tests must be done to make the diagnosis of OSD if it is suspected. In OSD, the spinal cord may not grow correctly along with the spinal bones. This can lead to serious problems as a child grows.

  • Meningocele. A meningocele is a sac filled with spinal fluid that is pushed out onto the skin. The sac is usually on the back. There is commonly no nerve damage with this problem. People with a meningocele may have minor disabilities.

  • Myelomeningocele (also called meningomyelocele) . This is the most severe form of SB. This causes parts of the spinal cord and nerves to come through the open part of the spine into a sac on the skin at birth. It causes nerve damage and other disabilities. Most children with this problem also have too much spinal fluid around their brains (hydrocephalus). The spinal fluid is unable to drain like it should. The fluid builds up. This causes pressure and swelling.

CAUSES

The causes of SB are not fully known. Having one child with SB increases the risk of having another child with SB.

SYMPTOMS

  • Occult spinal dysraphism (OSD) . Babies with OSD have a dimple in their lower back. They also may have birthmarks or hairy patches. Sometimes a skin tag or lump is present. Symptoms may appear with growth. This is because the spinal cord does not grow correctly along with the spinal column. This causes the spinal cord to get stretched, leading to nerve problems. Symptoms in babies may be absent, or there may be weakness or deformities of the legs. Older children or adults can have severe low back pain, loss of control of the bladder or bowels, leg weakness, and difficulty walking.

  • Meningocele .Babies have a sac filled with spinal fluid, commonly located along the back. The nerves usually are not damaged, so usually there are no symptoms.

  • Myelomeningocele . This usually leads to deformities of the joints in the legs. The patient may not be able to move his or her legs (they may be paralyzed) partially or completely. Walking may be difficult. There may be problems with urine and bowel control. There can be urine or bowel leakage (incontinence) or constipation. Backup of spinal fluid around the brain can cause the head to swell, resulting in irritability, vomiting, unusual tiredness, and other symptoms. There can be loss of feeling in the legs.

TREATMENT

  • Occult Spinal Dysraphism (OSD) .OSD is treated by early surgery to relieve or prevent the stretching of the spinal cord. Sometimes other surgery and medications are needed to treat pain.

  • Meningocele . The treatment of meningocele usually only includes surgical closure of the defect.

  • Myelomeningocele (meningomyelocele) . Surgery to close the fluid-filled sac is done in the first few days of life. A drainage tube may be needed to drain the excess spinal fluid and pressure around the brain. Generally, a team of specialists is needed to treat this lifelong problem. Orthopedic surgery and bracing may be needed for leg, foot, and hip deformities. The kidneys and bladder need to be looked at by a urologist. Treatment for urine control issues is often needed. Urinary tract infections can be prevented with medication and other treatments. Diet, medication, and enemas can be used for bowel control.

HOMECARE INSTRUCTIONS

Home treatment of OSD and meningocele is usually geared toward treatment of symptoms after surgery and pain management. Home care will depend on the type of surgery done and the surgeon's judgment.

Myelomeningocele home treatment is directed by the team of specialists involved with the patient. It involves attention to bowel and urinary emptying and hygiene. Good skin hygiene and avoidance of hot baths and other heat sources are important to avoid skin damage to the legs. Depending on the degree of nerve and joint problems, walking may be possible with braces, crutches, or walkers. Sometimes a wheelchair is needed.

PREVENTION

Women able to become pregnant can take 400 mcg of folic acid every day during pregnancy and before becoming pregnant. This can reduce her risk of having a baby with spina bifida by as much as 70%.