Spina Bifida

Spina bifida is a structural birth defect that affects the spine. It happens when the babys spine and spinal cord dont form properly. Let us have a look on its types, causes, symptoms and how this disease is diagnosed and treated.

Last Updated: 23 October 2020

Spina Bifida
Spina Bifida

 

What is spina bifida?

Spina bifida means “Split spine” or “cleft spine” and it is a type of neural tube defect. Neural tube is an embryonic structure that is formed early in pregnancy. It is a narrow sheath that closes to form the brain and spinal cord of the embryo. 

During the process of embryonic development, the top portion of the neural tube becomes the brain and the remainder becomes the spinal cord.  This process of closure of neural tube gets over by the 28th day of pregnancy. The problems that happen during this process results in a condition called spina bifida. In this condition, spine does not close fully, and results in damage to the spinal column.

In some cases, this defect can be very much visible which can result in an opening in the back. In others, there can be no opening and the defect remains concealed under the skin.

Prevalence

Out of 4 million babies born in the United States each year, approximately 1500 to 2000 babies are affected by this condition.

Types of Spina Bifida

There are four main types of spina bifida. The severity of the disease depends on the location, type and size.

1. Spina bifida occulta (“Occulta” means hidden): This is the most common type and it is the mildest form of spina bifida. There might be a small gap in the spine, but the spinal cord and nerves will be fine. This form does not cause any disabilities.
2. Meningocele: In this type, the spinal cord develops normally, but a sac filled with fluid protrudes through an abnormal vertebral opening. Some people have no or fewer symptoms while others may have bowel dysfunction.
3. Myelomeningocele: This is the most severe form of spina bifida. Here the spinal cord is exposed through an opening in the spine, resulting in paralysis of the body parts.
4. Closed neural tube defects: In this form, the spinal cord is marked by malformations of fat, bone, or meninges. 

Symptoms of Spina bifida

The symptoms differ based on the type of spina bifida.
·         Abnormal tuft or clump of hair or a small dimple or birthmark
·         Weakness or paralysis of legs
·         Curved spine
·         Urinary and bowel incontinence
·         Seizures
·         Life threatening infections
 

Causes of Spina bifida

The exact cause of spina bifida is not known. Genetic and environmental factors may have a role in the pathogenesis of the disease.
1. Folic acid: Folic acid is necessary for healthy development of a baby. Folic acid (vitamin B9) insufficiency is linked with development of neural tube defects and spina bifida. 
2. Obesity and diabetes: Pre pregnancy obesity and uncontrolled diabetes of the mother are risk factors for spina bifida.
3. Family history: Parents who have one child with spina bifida have slightly a higher chance of having another baby with similar defect. A mother who had had this defect may deliver a baby with spina bifida.
4. Increased body temperature: Increase in body temperature due to fever or use of hot tubs during early weeks of pregnancy could be associated with risk of spina bifida.
5. Medications: Usage of medicines like valproic acid can cause spina bifida. These medicines interfere with the body’s ability to use folic acid.

Diagnosis of Spina bifida

Prenatal test:
Maternal serum alpha fetoprotein test: A blood sample will be drawn from mother to check the levels of alphafeto protein. AFP is a protein that a baby produces, small amount of it crosses the placenta and enters the mother’s bloodstream. High levels of AFP indicate the risk of neural tube defects. This test is performed during 16 to 18 weeks of gestation. If there is more than one fetus and there is miscalculation of gestational age, the levels of AFP may be high. In such cases, ultrasounds are necessary to confirm the diagnosis.
Ultrasound: An open spine or a sac poking out of the spine can be detected through ultrasound examination.
 Amniocentesis: High levels of AFP can be detected through amniocentesis in which a doctor uses a needle to remove a sample of fluid from the amniotic sac that surrounds the baby.
 Postnatal diagnosis:
After the birth of a baby, the intensity of spina bifida is detected through X rays, CT and MRI scans.

Treatment of Spina bifida

There is no cure for spina bifida. The mild form of it does not require any treatment.
Surgeries:
Surgery before birth: Some of the specialized medical centers perform fetal surgery to correct the spinal defect in utero. This is done during the 26th week of pregnancy and is done by opening the uterus and repairing the baby's spinal cord. Though this procedure has its own pitfalls, it has shown promising results in improving the baby’s outcome.
Surgery after birth: A child born with this defect will have surgery to close the spinal defect.  This helps to minimize the risk of infections and help protect the exposed nerves from trauma.
Treatment for complications:
Some of the complications like weak legs, bladder and bowel problems or hydrocephalus require treatment soon after a baby is born.
Children with spina bifida may require assistive devices like braces, crutches, or wheelchairs for mobility.
Bowel and bladder problems require oral medications and bladder catheterizations.
Babies who have hydrocephalus require surgery to ease the buildup of fluid around the brain.
Twenty to fifty percent of children with myelomeningocele may develop a condition called tethered cord syndrome which is rectified through surgery.
 
Prevention

Spina bifida cannot be prevented. Women need to consume 400 micrograms of folic acid during the child bearing age to help reduce the risk of neural tube defects. Folic acid is found in dark green vegetables, egg yolks, and some fruits.

Children with spina bifida tend to have normal intelligence. With the accurate medical care, children can lead normal lives.
 
 
 
 

 

 

 

 

 

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