Presented By MD. MONSUR RAHMAN MPT (Musculoskeletal disorders)

1. SPINA BIFIDA
Presented
By
MD. MONSUR RAHMAN
MPT (Musculoskeletal disorders)

2. INTRODUCTION
 Spina bifida is a neural tube defect which
occurs since neural groove fails to fuse
completely during the formation of neural
tube.
 Spinal cord develops from thickening of the
neural ectoderm called as medullary plate .
 Medullary plate invaginates to form
medullary tube.
 Closure completed by end of 4 weeks.

3. Cont……….
 Mesodermal segment gives rise to vertebral
coloumn, meninges,blood vessels of spinal
cord.
 In spina bifida oculta or cystica the above
process is deranged.

4. ETIOLOGY
 Both genetic & environmental factors
involved.
 Recurrence rate after birth of 1 affected child
is 1.5% & increases to 5% after 2 affected
sibilings.
 Folic acid deficiency & valproic acid intake , X-
ray exposure, infection increases the risk.

5. SPINA BIFIDA OCCULTA
 Rarely symptomatic
 Failure of fusion of laminae with absence of
spinous process
 L5 & S1 commonly involved
 Symptoms due to
hydromelia,diastematomyelia,congenital tumor.
 Sub-cutaneous skin –tuft of
hair,telangiectasia,sub-cutaneous lipoma

9. Cont……..
 Unilateral foot deformity & weakness of foot
muscles.
 Smallness of foot, tropic ulcers,pes cavus
occurs.
 Sensory loss in L5 & S1.
 Bladder sphincter incontinence – urinary
incontinence, dribbling , UTI
 weakness of anal sphincter with sensory
impairment in perineal region.

10. SPINA BIFIDA CYSTICA
 Meningocele: meninges.
 Meningomyelocele: meninges & spinal cord.
 MENINGOCELE: cystic lesion in mid line of back
containing only meninges or with nerve roots
free of all other CNS tissues well covered with
skin & unasssociated with neurological deficit.
 Frequency is equal in all regions.

12. MENINGOMYELOCELE
 Neural ectoderm developing into spinal cord
,roots has failed to separate from epithelium
leading to sac containing CSF, incompletely
formed meninges & malformed spinal cord.
 Defect covered by transparent membrane.
 Neural plate is exposed as reddened, weeping
area,stroking invoke involuntary movements.
 Commonest in lumbo-sacral region, rarely
can be anterior.

13. Cont………
 Associated with Arnold-Chiari
malformation,aqueductal stenosis,arrest of
migration of cerebral neurons, hydrocephalus.
 Sacral-: LE normal with loss in saddle area,in
sphincter[ inability to initiate , dribbling]
 Lumbo-sacral-:paralysed ankle[ inverted,
equinovarus]
 Thoraco-lumbar -: spastic LE ,poorly developed
lower abdominal , dislocated hips , cutaneous &
sphincter involvement.


14. MANAGEMENT
 Multi-disciplinary
 Prevent infection & timely closure of defect
 After repair of meningomyelocele shunting
procedure for hydrocephalus is required.
 Bladder management:- intermittent
catheterisation,prophylatic anti-biotic,
reimplantation of ureters or external drianage
of bladder .

15. Thank You