Spina Bifida

Definition

Spina bifida is a type of birth defect. It is a problem with how the spine and spinal cord develops. Spina bifida can begin to develop in a fetus before the mother even knows she is pregnant. In some cases, structures that should be inside the spinal canal can slip out. The structures affected may include:

• Membranes that surround the spinal cord
• Nerve roots that connect nerves to the spinal cord
• Spinal cord
• Vertebra (back bones)—may be deformed

Spina Bifida

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There are three kinds of spina bifida:

• Occulta—small defect in one or more backbones, least severe form, usually no complications
• Meningocele—membranes poke through an open part of the spine and can form a cysts
• Myelomeningocele—most severe form of spina bifida, membranes poke through and contain nerve roots or spinal cord and can lead to
  • Paralysis and incontinence of bowel and bladder may occur—frequently not cured by surgery
  • Hydrocephalus—a build up of fluids in the brain that increase pressure on the brain

Causes

The cause of spina bifida is not known. There is a strong genetic factor for some with spina bifida. This means there is a problem with the body's blueprint.

Many studies have also shown a link between a low folate diet in the mother and birth defects. In particular, low folate diets are associated with an increased risk of spina bifida.

Risk Factors

Factors that increase the risk of spina bifida include:

• Low maternal blood level of folic acid at the time of conception
• Family history of spina bifida
• A mother who had a previous pregnancy with a neural tube defect
• Mother's race: Hispanic or Caucasian of European origin
• Certain medications given during pregnancy
• Gender: Girls are more likely to have spina bifida.

Symptoms

Occulta may not have any symptoms. Some with this type may never know they have spina bifida. There may be a small tuft of hair or skin discoloration over the low back.

The immediate symptoms of meningocele and myelomeningocele include:

• Sac filled with fluid leading out from the baby's spine
• Spinal cord and tissue may also protrude through the back

Infants and children with meningocele or myelomeningocele spina bifida may also experience long-term symptoms such as:

• Bowel and bladder problems
• Frequent urinary tract and other infections
• Learning disabilities
• Accumulation of fluid in the brain
• Scoliosis —abnormal curve to spine
• Inability to walk
  • Muscle weakness and paralysis of the lower extremities
  • Hip dislocation
  • Foot and ankle deformities
• Many children with myelomeningocele are wheelchair bound

Diagnosis

Treatment

Occulta spina bifida requires no treatment.

Meningocele spina bifida is treated with surgery. It is done to remove the cyst. This form of spina bifida can be treated.

Treatment for myelomeningocele spina bifida is very complicated. It may include surgery to place nerves and spinal cord back in place, physical therapy for any physical problems, and supportive care for any other complications. Treatments for myelomeningocele may include:

Prevention

To help reduce the chance that your baby will be born with spina bifida:

• If you plan to have a baby, take a folic acid supplement with at least 400 micrograms every. The supplements must begin before the baby is conceived. They should also be continued throughout the pregnancy. A vitamin supplement containing folate may be the most reliable method of getting folate but you can get it from food as well. Foods with significant quantities of folate include:
  • Leafy green vegetables
  • Orange juice
  • Beans
  • White flour products and cereals fortified with folate
• Plan your pregnancy. Talk to your doctor if you have any of the risk factors listed above. Ask your doctor if any medicines that you take increase the risk of having a baby with spina bifida.