This document discusses several congenital and degenerative diseases of the vertebral column and spinal cord. It describes spina bifida occulta as an incomplete formation of a single lamina that often produces no symptoms. Meningocele and myelomeningocele result from failure of the neural tube to close, herniating meninges and neural elements. Myelomeningocele is the most common severe birth defect of the spine. The document also discusses conditions associated with spina bifida like latex allergy, anesthetic considerations for these patients, and tethered spinal cord syndrome caused by abnormal spinal cord attachments.

1. Saeid Safari,MD.

2. Saeid Safari,MD.
CONGENITAL AND
DEGENERATIVE DISEASES OF
THE VERTEBRAL COLUMN AND SPINAL CORD
SPINA BIFIDA OCCULTA
MENINGOCELE
MYELOMENINGOCELE
TETHERED SPINAL CORD SYNDROME

4. Saeid Safari,MD.
SPINA BIFIDA OCCULTA
• Incomplete formation of a single lamina in the lumbosacral spine
without other abnormalities.
• A congenital defect that is present in an estimated 5% of
individuals.

5. Saeid Safari,MD.
SPINA BIFIDA OCCULTA
• It usually produces no symptoms and is often discovered as an
incidental finding on radiographic examination during evaluation
of some other unrelated disease process.
• Because there are no associated abnormalities, an increased risk
with spinal anesthesia is not expected, and large numbers of
these patients have undergone spinal anesthesia safely.

6. Saeid Safari,MD.
MENINGOCELE AND MYELOMENINGOCELE
• Failure of the neural tube to appropriately close in the caudal
segments results in neural tube defects.
• Herniation of contents of the spinal canal result in meningocele
and myelomeningocele if the herniated contents contain only
meninges and cerebrospinal fluid (CSF) versus meninges,
CSF, and neural elements, respectively.

7. Saeid Safari,MD.
MENINGOCELE AND MYELOMENINGOCELE
• Meningocele is relatively rare and usually associated with a lower incidence
and severity of neurologic deficits.
• Myelomeningocele is the most common severe congenital anomaly of the
spine.
• Although it usually occurs in the lumbosacral region, myelomeningocele can also
occur in cervical or thoracic regions of the vertebral column and cord.

8. Saeid Safari,MD.
MYELOMENINGOCELE
• Increased risk for this defect is associated with maternal folate
deficiency.
• Trisomy 13, trisomy 18, and type II Chiari malformations.
• Hydrocephalus can also occur, especially in the presence of a
type II Chiari malformation.

9. Saeid Safari,MD.
CONDITIONS ASSOCIATED WITH
SPINA BIFIDA
• Attention and Learning Difficulty
• Bladder Function
• Bowel Function
• Depression
• Epilepsy and Seizures
• Hip Displacement
• Hydrocephalus
• Latex Allergy
• Vision
• Lymphedema
• Obesity
• Pressure Injury
• Scoliosis
• Sleep Apnea
• Sexual Function and Infertility
• Tethered Spinal Cord
• Weakness or Paralysis

10. Saeid Safari,MD.
LATEX ALLERGY
• This is an extremely dangerous allergy to substances that contain
latex. It is common in individuals with spina bifida.
• Latex allergy is a result of repeated exposure to latex, particularly in
exposure to the mucous membranes.
• Some will develop a rash when latex touches their bodies, but many
can develop severe breathing issues from inhaling latex dust and
odor.

11. Saeid Safari,MD.
LATEX ALLERGY
• Avoidance of latex products to reduce exposure is necessary.
• This includes many medical supplies and equipment (most are labeled as
non-latex due to this severe allergy in many individuals), baby supplies like
bottles, nipples and pacifiers, toys, latex balloons, and foods such as
avocados, bananas, chestnuts, kiwi and passion fruit.
• Because latex allergy is so dangerous, parents and pediatric hospitals only
allow mylar balloons.

12. Saeid Safari,MD.
ANESTHETIC CONSIDERATIONS:
• Latex sensitivity: so perioperative exposure to latex should be avoided.
• Avoidance of succinylcholine because of increased risk for hyperkalemia in the setting of
motor deficits.
• Resistance to nondepolarizing muscle relaxants can occur in weak extremities, so
titration of muscle relaxant dose should not be based on monitoring of the lower extremities.
• Be aware of other neurologic deficits that may be related to hydrocephalus, such as the
presence of a CSF-diverting shunt or Chiari malformation.

13. Saeid Safari,MD.
TETHERED SPINAL CORD SYNDROME
• During fetal development the vertebral column develops and
elongates faster than the spinal cord. Abnormal attachments of the
spinal cord to the vertebral column can result in stretching of the
spinal cord and development of tethered spinal cord syndrome.
• These abnormal attachments can occur in the setting of
myelomeningocele, dermal sinus tracts, lipomatous tissue in the
spinal canal, diastematomyelia (a bifurcated spinal cord), or a filum
terminale of reduced elasticity.

14. Saeid Safari,MD.
TETHERED SPINAL CORD SYNDROME
• Spinal anesthesia should be avoided in these patients to reduce
risk of exacerbation of neurologic deficits.
• In patients with motor deficits, succinylcholine should be avoided
owing to risk for hyperkalemia.
• Resistance to nondepolarizing muscle relaxants can also occur.

15. Saeid Safari,MD.

16. Saeid Safari,MD.
THANKS
FOR YOUR KIND ATTENTION!