تعريف اسباب اعراض و علامات معالجخ

1. SPINA BIFIDA
Prepared by /Mohammed Alshehari

2. SPINA BIFIDA
This is due to the failure of the fusion of the two
vertebral arches in the embryological stages of
development of spine. The failure of fusion
could be limited, only to the spinous process
resulting in spina bifida occulta, the most
common variety or the entire vertebral arch
including the neural elements may fail to fuse
giving rise to the rare variety of spina bifida
aperta

3. different types of spina bifida: (A) Spina bifida
occulta, (B) Spina bifida aperta (meningococele),
(C) Myelomeningocoele,(D) Myelocoele

4. Incidence
Spina bifida is one of the most common birth
defects, with an average worldwide incidence
of 1-2 cases per 1000 births, but certain
populations have a significantly greater risk.

5. Causes
Spina bifida is caused by the failure of the neural
tube to close during the first month of
embryonic development (often before the
mother knows she is pregnant). Normally, the
closure on the neural tube occurs around 28
days after fertilization. However, if something
interferes and the tube fails to close properly, a
neural tube defect will occur.

6.  Unknown In majority of cases the cause is still
not known.
 Medications During pregnancy like
anticonvulsants, diabetes,
 Genetic It could run in families and there could
be a genetic basis for the condition
 Obesity Obese pregnant ladies are more
prone
 Folic Acid deficiency (folate) is a contributing
factor in the pathogenesis of neural tube

7. SPINA BIFIDA OCCULTA
This is the most common variety and is generally
mild. Lumbosacral spine and the first sacral
vertebra are commonly affected

8. Clinical Features
The disease is most of the times asymptomatic.
But however in few cases the overlying skin
may be normal or there may be presence of a
tuft of hair, pigmentation, lipoma, dimple,etc.
There may be muscle imbalance in the lower
limbs resulting in equinovarus or cavus
deformity of the foot due to tethering of the
cord by a membrane either to the skin or filum
terminale. Rarely there could be a bifid cord.

9. Radiograph
Plain X-ray of the affected spine helps to identify
the defect in the spine.

10. SPINA BIFIDA APERTA
Here the defect involves the vertebral arches,
skin meninges and cord. The following
varieties are described:
 Meningocoele in which there is protrusion of
the meninges.
 Myelomeningocoele in which there is
protrusion of meninges and cord.

11. Clinical photograph showing
the Meningomyelocele

12. • Syringomyelocoele in which the central canal of
the cord is dilated and the cord is protruded.
• Myelocoele in which the central cord remains
unfused and exposed.

13. Clinical Features
Next to spina bifida occulta, myelocoele is the
next common variety. Most of the cases of
spina bifida aperta are either stillborn or die
within few days of birth. The surviving children
may suffer from severe orthopedic deformities,
bladder and bowel incontinence and foot
deformities.

14. Physiotherapy Measures in
Spina Bifida
• Measures to correct deformities
This consists of:
— Night splints
— Passive stretching of soft tissues contractures
— Proper positioning and re-education of the
tendons after tendon transfers.

15. • Measures to manage paralysis of muscles
— To enable crutch walking, strength and
develop the arm and shoulder muscles.
— Strengthening exercises to the weight bearing
muscles like hip extensors and abductors,
knee extensor, ankle plantar and dorsiflexors.
— Measures to train body equilibrium.
— Retraining and reeducation of the transplanted
muscle.

16. • Proper skin to prevent pressure sores and
ulcers.
• Proper bowel and bladder care.
• Measures of ambulation and gait training.