for medical and allied Health Professionals

1. Subash Srivastav
Asst Professor

2. Definition
 Congenital defect in the posterior bony wall of the
spinal canal involving the laminae
 Most commonly seen in the lumbosacral region

3. Development of Spinal cord
2 weeks
5 weeks

4. Development of vertebral column
 Notochord – solid rod of cells in front of neural tube
 Vertebral bodies develop around Notochord
 From each vertebral body 2 projections grow around
the neural tube to form Vertebral arch OR Neural arch
 Fusion occurs first in the Thoracic region and extends
upwards and downwards
 Failure of fusion of these arches – SPINA BIFIDA

5. Incidence
 0.1% , excluding spina bifida occulta
 Myelocele – commonest type
 Most are still born; in survivors death occurs early due
to infection

6. Types
 Spina bifida occulta
 Meningocele
 Meningomyelocele
 Syringomyelocele
 Myelocele

9. Spina bifida occulta
 Common in lumbar/sacral region
 Small gap in one of vertebral arches (frequently only
one vertebra is involved)
 Gap is filled with fibrous tissue – no protrusion of cord
or membrane
 Indicators – patch of hair, lipoma, sinus, depression
 When cord lags behind vertebral column growth –
neurological deficiencies (nocturnal eneuresis,
backache)
 Many are symptomless

10. Meningocele
 Protrusion of meninges containing only CSF – cystic
swelling which is compressible
 Overlying skin remains intact
 Common in lumbosacral region; also occipital & root
of nose
 No neurological manifestations
 If associated with hydrocephalus (Arnold Chiari synd)
 Complications – infection, rupture
 Surgery required as early as possible

11. Myelomeningocele
 Spinal cord along with meninges in the sac
 Frequently adherent to the posterior aspect of sac
 Skin maybe absent at the summit of the swelling –
infection
 Transillumination – nerves within sac
 Neurological manifestations are ALWAYS present –
B/L talipes Equino Varus, atropy of lower limbs or
paralysis of lower limbs, urinary obstruction,
hydronephrosis & UTIs
 Surgery - ASAP

12. Syringomyelocele
 Rarest variety
 Central canal of spinal cord is dilated and the spinal
cord lies within the sac together with nerves
 Gross neurological deficits and paralytic
manifestations are seen

13. Myelocele
 Most serious form
 Along with bony defect, there is defect in development
of spinal cord
 Defect discharges CSF continuously
 Most are still born, survivors die within a few days due
to infection
 Meningomyelocele – most common defect among living
children with NTD