Brief description of spina bifida and its PT management

1. SPINA BIFIDA
DR. SUNANDA BHOWMIK(PT)
B.P.T, M.P.T (Paediatric & Neonatal Physical
Therapy)
Double Gold Medallist
Assistant Professor
MMIPR,MM(DU)

2. • Spina bifida is one type of neural tube birth defect causing
neuromuscular dysfunction.
• Spina bifida is a spinal defect usually diagnosed at birth by the
presence of an external sac on the infant’s back. The sac contains
meninges and spinal cord tissue protruding through a dorsal defect
in the vertebrae. This defect may occur at any point along the
spine, but is most commonly located in the lumbar region.

4. TYPES
• Spina bifida occulta, myelocele, lipomeningocele
• Spina bifida occulta is a condition involving nonfusion of the
halves of the vertebral arches, but without disturbance of the
underlying neural tissue. This lesion is most commonly located in
the lumbar or sacral spine and is often an incidental finding when
imaging is done for unrelated reasons
• Spina bifida occulta may be distinguished externally by a midline
tuft of hair,

5.  A myelocele is a protruding sac containing meninges and
cerebrospinal fluid (CSF), but the spinal cord and nerve roots
remain intact and in their normal positions. There are typically no
motor or sensory deficits, hydrocephalus, or other central nervous
system (CNS) problems associated with a myelocele
 Lipomeningocele is a superficial fatty mass in the low lumbar or
sacral region of the spinal cord and is usually included with this
group of diagnoses. Significant neurologic deficits and
hydrocephalus are not expected in patients with a lipomeningocele.
A higher chance of distal leg and foot motion dysfunction, &
bladder and bowel dysfunction

6. EMBRYOLOGY
• It occurs early in the embryologic development of the CNS.
• Cells of the neural plate, which forms by day 18 of gestation,
differentiate to create the neural tube and neural crest.
• The neural crest becomes the peripheral nervous system,
including the cranial nerves, spinal nerves, autonomic nerves,
and ganglia.
• The neural tube, which becomes the CNS, the brain, and the
spinal cord, is open at both the cranial and caudal ends. Over a
period of 2 to 4 days, the cranial end begins to close and this
process is completed on approximately the 24th day of gestation.(
Anencephaly)
• The caudal end of the neural tube closes on approximately day 26
of gestation. Failure of the neural tube to close at any point along
the caudal border initiates the defect of spina bifida cystica or
myelomeningocele.

8. Hydrocephalus
Hydrocephalus is an abnormal accumulation of CSF
in the cranial vault. In individuals without spina
bifida, hydrocephalus may be caused by
overproduction of CSF, a failure in absorption of CSF
fluid, or an obstruction in the normal flow of CSF
through the brain structures and spinal cord.

9. • Obstruction by the Arnold–Chiari malformation is
considered to be the primary cause of
hydrocephalus in most children with Spina Bifida
• This malformation, also known as the Chiari II
malformation, is a deformity of the cerebellum,
medulla, and cervical spinal cord.
• The posterior cerebellum is herniated downward
through the foramen magnum, with brainstem
structures also displaced in a caudal direction.

10. • The CSF released from the fourth ventricle is
obstructed by these abnormally situated
structures, and the flow through the foramen
magnum is disrupted.
• Traction on the lower cranial nerves also occurs
and is associated with the malformation.

11. • Studies using magnetic resonance imaging
(MRI) have shown that most children with
spina bifida have the Chiari II malformation.
Among those with this malformation, the
likelihood of hydrocephalus developing is
greater than 90%.

12. THANK YOU