Definition

• Spina bifida is a congenital disorder caused by an incomplete development of the spinal column during the first month of pregnancy.  There are three types of spina bifida:
  
   

1. Spina Bifida Occulta -- the mildest form, in which one or more vertebrae are not closed, but there is no protrusion of the spinal cord and meninges (a protective covering around the spinal cord).

2. Meningocele -- the meninges protrude from the opening in the vertebrae but the spinal cord remains intact.

3. Myelomeningocele -- the most severe form, in which a portion of the spinal cord and meninges protrude from the opening in the spine.

Causes

• Family history of spina bifida

• Increased maternal or paternal age

• Folic Acid Deficiency before and during the first month of pregnancy

Symptoms

• Infants born with spina bifida have a skin dimple with a tuft of hair on the back and a protruding sac over the spine.  In some cases, the sacs are covered with skin.

• There is a higher risk of infection if the spinal cord and nerves are exposed.

• Besides the spina bifida, other defects can occur.  These include hydrocephalus, Chiari malformation and syringomyelia (accumulation of cerebrospinal fluid within the spinal cord).  About 80 to 90% of children with myelomeningocele have hydrocephalus

• Nerve and spinal cord damage results in varying degrees of paralysis of the lower limbs, as well as loss of bladder and bowel control

Screening and Diagnostics

• Visualization of the defect or sac on the back

• Spine X-Ray shows the bony defect

• A spine MRI scan is used to detect the damage of the spinal cord and nerve tissues

Treatment

• In meningomyelocele, prompt surgery must be performed within 24 hours after birth to prevent infections and further damage to the spinal cord.

• If the child has a permanent disability, physical therapy, proper braces or a wheelchair can improve the mobility of the patient.  Many children with myelomeningocele need medications and training to manage their bladder and bowel functions.

Prevention

     Folic Acid Deficiency may increase the risk of neural tube defects, including spina bifida, so it is recommended that all women of child-bearing age consume 0.4 mg of folic acid daily to reduce the risk of having a pregnancy affected by a neural tube defect.