• (Latin: "split spine") is a developmental congenital disorder caused by the incomplete closing of the embryonic neural tube. Some vertebrae overlying the spinal cord are not fully formed and remain unfused and open. If the opening is large enough, this allows a portion of the spinal cord to protrude through the opening in the bones. There may or may not be a fluid-filled sac surrounding the spinal cord.

CATEGORIES

• SpinaBifida Occulta• Spina Bifida

Cystica(myelomeningocele)• Meningocele

- The most common location of the malformations is the lumbar and sacral areas

SIGNS & SYMPTOMS

Physical signs of spinal bifida may include:

• Leg weakness and paralysis • Orthopedic abnormalities (i.e., club foot, hip

dislocation, scoliosis)• Bladder and bowel control problems,

including incontinence, urinary tract infections, and poor renal function

• Latex allergy• Pressure sores and skin irritations • Abnormal eye movement

Social Complications • typically developing children, youth

with spinal bifida may have fewer friends and spend less time with peers

• children with spinal bifida have also reported feeling less close to their friends and feel they do not receive as much emotional support from their friendships

PATHOPHYSIOLOGY

• Spina bifida is caused by the failure of the neural tube to close during the first month of embryonic development (often before the mother knows she is pregnant).

• Normally the closure of the neural tube occurs around the 23rd (rostral closure) and 27th (caudal closure) day after fertilization However, if something interferes and the tube fails to close properly, a neural tube defect will occur.

• Lack of folic acid (folate) is a contributing factor in the pathogenesis of neural tube defects, including spinal bifida

Spina Bifida Occulta Spina Bifida Occulta

• Spina bifida occulta describes a group of neural tube birth defects that can affect the spinal column. This is composed of bones, or vertebrae, which support the nerve center of the spinal cord, which is responsible for carrying all nerve signals in between the body and the brain.

CAUSES:

- have a parent or sibling with spina bifida are about 8 times more likely to have this disorder as well. - lack of folic acid in the mother’s diet.

SIGN & SYMPTOMS

• Hairy patch on the skin• Dark spots or birth marks• A red or purple spot on the back composed

of blood vessels• Dimpling in the back• An area that has less skin color than other

areas• Numbness or loss of sensation in the legs• Weakness or mild pain in the lower half of

the body• Changes in bowel or bladder function

Types of Occulta

• Spinal cord ending is too thick• Tethered spinal cord – the lower end of the spinal

cord does not attach to the rest of the body, allowing it to potentially get damaged or stretched out

• Fatty lumps inside of the spinal cord• Split spinal cord – the cord is split into two

halves• The skin of the back and the spinal canal are

connected by tissue

MENINGOCELE

• least common form of spina bifida is a posterior meningocele (or meningeal cyst)

• In a posterior meningocele, the vertebrae develop normally, however the meninges are forced into the gaps between the vertebrae. As the nervous system remains undamaged, individuals with meningocele are unlikely to suffer long-term health problems

• causes of meningocele include teratoma and other tumors of the sacrococcyx and of the presacral space, and Currarino syndrom, Bony defect with outpouching of meninges.

• A meningocele may also form through dehiscences in the base of skull. These may be classified by their localisation to occipital, frontoethmoidal, or nasal. Endonasal meningoceles lie at the roof of the nasal cavity

MYELOMENINGOCELE• Type of spinal bifida is the most common and often

results in the most severe complications.• Myelomeningocele, the spinal cord also pushes

through the hole within the sac that the meninges makes by extending through the opening.

• Myelomeningocele patients usually also develop Hydrocephalus, as well as the most severe Spina Bifida disabilities, some of which are lower body paralysis, problems with bladder and bowel control, and numbness.

• People may have ambulatory problems, loss of sensation, deformities of the hips, knees or feet and loss of muscle tone. Depending on the location of the lesion, intense pain may occur originating in the lower back, and continuing down the leg to the back of the knee.

INDICATION

• Both conditions can be very visible in a protruding sac on the spine at birth or seen in an ultrasound. However, the signs may be less noticeable such as birthmarks, skin discoloration, or extra hair or fatty tissue at a spot along the spinal column. Certainly, any symptoms, such as paralysis, should be looked at as potential warning signs.

PREVENTION

• dietary supplementation with folic acid has been shown to be helpful in preventing spina bifida

• folic acid for women of childbearing age and women planning to become pregnant is at least 0.4 mg/day of folic acid from at least three months before conception, and continued for the first 12 weeks of pregnancy.

• pregnancy screening :Neural tube defects can usually be detected during pregnancy by testing the mother's blood or a detailed fetal ultrasound

TREATMENT

• The surgery to correct the two conditions is pretty much the same, but surgery to fix a Meningocele protrusion is approach in a less urgent way than the surgery for a Myelomeningocele. This is because the effects on the nervous system of a Myelomeningocele are usually immediately apparent and more severe. With Myelomeningocele, surgery will usually be performed within one to two days after birth. The physician should keep routine measurements of the head, watching for signs of Hydrocephalus. Other surgeries may be necessary to correct problems with issues arising from damage to the nervous system.