2. SPINA BIFIDA
A congenital defect of the spine in
which part of the spinal cord and
its meninges are exposed through a
gap in the backbone, often
causing paralysis of the lower limbs.
3. Etiology
1. Unknown but thought to be multifactorial including
genetic, nutritional, environmental factors.
2. Low levels of folic acid are thought to play a role.
3. Four types of spina bifida: Occulta, closed neural tube
defects, meningocele, and myelomeningocele.
4. .
a. Occulta: A layer of skin covers the
malformation, present in 10–20% of the
general population, rarely causes disability or
symptoms.
b. Closed neural tube defects: Malformation
of fat, bone, or meninges.
c. Meningocele: Spinal fluid and meninges
protrude through an abnormal vertebral
opening.
d. Myelomeningocele: Spinal cord/neural
elements are exposed
5. B. Occurrence
. 1. 3.40 per 10,000 births.
2. Racial differences noted; Hispanic women (4.17 per 10,000)
have the highest incidence compared with non-Hispanic white
women, 3.22 per 10,000, and non-Hispanic black women, 2.64
per 10,000.
3. Girls have slightly higher risk (1.2:1
6. Clinical manifestations.
1. Infants.
a. Lethargy.
b. Poor feeding.
c. Irritability.
d. Stridor.
e. Ocular motor incoordination.
f. Development delay
7. Older children may present with the following:
a. Cognitive or behavioral changes.
b. Decreased strength.
c. Increased spasticity.
d. Changes in bowel or bladder function.
e. Lower cranial nerve dysfunction.
f. Back pain.
g. Worsening spinal or lower extremity orthopedic deformities.
8. D. Physical findings.
1. Abnormal tuft or clump of hair.
2. Small dimple or birthmark on the skin at the site of the
spinal malformation.
3. Visible fluid-filled sac protruding from the spinal canal.
9. E. Diagnostic tests
1. Prenatal diagnosis:
Fetal ultrasound at 16–18 weeks’ gestation.
2. Postnatal diagnosis: Plain film X-ray, CT/MRI of
the spine.
10. F. Differential diagnoses.
1. Tethered spinal cord.
2. Mass lesions of the cord.
3. Diastematomyelia.
4. Cord cavitation and narrowing.
5. Adhesions.
6. Dural bands.
7. Uncontrolled hydrocephalus.
8. Chiari II malformation.
12. Treatment.
1. Depends on the type and severity of the disorder as well as
complications. 2. Children with the mildest form need no
treatment.
3. Some children will need subsequent surgeries to manage
problems with the feet, hips, spine.
4. May require assistive device, such as crutches, leg braces,
walkers, wheelchair.
5. Treatment for bladder and bowel problems typically begins
soon after birth, and may include bladder catheterizations and
bowel management regimens.
13. H. Follow-up.
1. Every 6 months in a specialized multidisciplinary clinic throughout childhood and
annually thereafter.
2. Depending on medical and surgical issues, more frequent visits with certain
specialists may be necessary.
14. I. Complications
. 1. Meningitis, in newborn period.
2. Chiari II malformation.
3. Hydrocephalus.
4. Intellectual disabilities and learning disabilities.
5. Latex allergies.
6. Bowel and bladder issues.
7. Depression during adolescence. J
15. Health Education
1. Need for multidisciplinary team.
2. High risk for latex allergy.
3. Special education issues.
4. Socioemotional issues in adolescence
