Spina bifida is a birth defect where the spine and spinal cord do not form properly, leaving an opening in the spine. It occurs in about 1-2 per 1000 live births. There are three main types: spina bifida occulta which has no symptoms, meningocele which is a sac protruding from the spine containing fluid and membranes, and myelomeningocele which is the most severe form where the spinal cord and membranes protrude out. Treatment depends on the type but may include surgery to close the opening after birth along with management to prevent infections and complications.

1. SPINA BIFIDA

2. SPINA BIFIDA
DEFINITION:
Spina bifida is a malformation of spine, in which
posterior portion of lamina of vertebra fail to close
with or without defective development of spinal
cord.
INCIDENCE:
1 or 2 per 1000 live births

3. ETIOLOGY:
1. Genetic
2. Maternal age
3. Environmental
4. Diet

4. CLASSIFICATION:
SPINA
BIFIDA
SPINA
BIFIDA
CYSTICA
MENINGOCELE
MYELOMENINGOCELE
SPINA
BIFIDA
OCCULTA

5. SPINA BIFIDA OCCULTA:
It is a defect which result from failure of formation
of bony arch around the spinal cord, but spinal cord
and meninges are normal. It is not visible externally
and is asymptomatic.

6. SPINA BIFIDA CYSTICA:
Spina bifida cystica is a defect in the closure of
posterior vertebral arch with protrusion of spinal
cord and meninges through the defect.
a) Meningocele:
It is a sac like herniation through the bony
malformation, containing meninges and
cerebrospinal fluid.
b) Myelomenigocele:
It is a sac like protrusion of spinal cord, CSF and
meninges through spinal cleft. It is mostly found in
lumbar or lumbosacral region.

7. PATHOPHYSIOLOGY:
It occurs due to defect in the orderly closure of
vertebral column and formation of spinal cord
during 4th or 6th weeks of gestation.
During the 3rd week of gestation, a depression
forms in the dorsal of the ectoderm in embryo.
This depression becomes deeper and its margins
close dorsally to create neural tube and that
becomes spinal cord and brain.
Exact mechanism by which neural tube defect
occurs is not certain.

8. CLINICAL FEATURES:
A. Spina bifida occulta:
Spina bifida occulta are asymptomatic, the only
features seen are:
• Dimple in the skin or growth of hair over
malformed vertebra.
• As the child grows, he may develop foot weakness
or disturbances of bladder and bowel sphincter.

9. B. Spina bifida cystica:
1. Meningocele:
• External cystic defect
• Weakness of leg or lack of sphincter control.
2. Myelomeningocele:
• Herniated mass in lumbosacral region
• Hydrocephalus
• Loss of motor control
• Congenital skeletal anomalies

10. DIAGNOSTIC EVALUATION:
Ultrasound
Fetal MRI
Amniocentesis
Sac may be seen on the back of the baby
CT scan and MRI of spinal cord and brain

11. MANAGEMENT:
 It depends on the nature and extent of defect.
Usually no intervention is required for spina bifida
occulta.
 For spina bifida cystica surgery is required
laminectomy and closure of the defect is done
within 24- 48 hours of birth.

13. NURSING MANAGEMENT:
The main aim of pre and post- operative nursing care
are:
• Prevention of infection
• Preventing injury to the sac
• Prevention of skin breakdown
• Preventing urinary tract infection
• Preventing leg and hip deformities
• Provision of adequate nutrition

14. PROGNOSIS:
Myelomeningocele can usually be surgically
corrected. With treatment, length of life is not
affected, but quality of life is improved.
COMPLICATION:
• Frequent urinary tract infection
• Hydrocephalus
• Loss of bladder and bowel control
• Meningitis
• Permanent weakness or paralysis of legs

15. PREVENTION:
• Genetic counseling of at risk couple may be
recommended.
• If severe defect is detected early in pregnancy,
therapeutic abortion may be considered.
• Folic acid supplements.