Definition of "Spina bifida"

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Spina bifida (Latin for "split spine" is a congenital disorder of development, caused by incomplete closing of the embryonic neural tube, and therefore the backbone and membranes around the spinal cord.

Patient information

What is spina bifida? It's sounds like something related to the spine? That it has some problems ?
Yeah, so it is related to the spine. It's where there is incomplete closing of the embryonic neural tube.

What's the embryonic neural tube?
Neural tube is a hollow structure from which the brain and spinal cord form. So, if it doesn't completely close, there's going to be problems with the brain or spinal cord.

Sx
  • The most common location is the lower back, but in rare cases it may be the middle back or neck
  • Associated problems include:
    • Poor ability to walk
    • Problems with bladder or bowel control
    • Hydrocephalus
    • Tethered spinal cord
    • Latex allergy
  • Learning problems are relatively uncommon

Patient information

Wait... don't you need a brain and spinal cord? What happens when you have incomplete closing of the hollow structure that becomes the brain and spinal cord?
So most commonly it is the lower back, actually. But it can be the middle back or neck. Also, it can result in other problems, like poor ability to walk. Problems with controlling the bladder or bowel. Enlargement of the brain's cavities due to build up of CSF fluid. Tissue attachments that limit the movement of the spinal cord within the spinal column. Allergic reactions to substances in natural rubber latex.

Pathophysiology
  • Some vertebrae overlying the spinal cord aren't fully formed, and remained 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
  • The most common location of the malformations is the lumbar and sacral areas
Risk factors
  • It is believed to be due to a combination of genetic and environmental factors
  • After having 1 child with the condition or if 1 of the parents has the condition, there is a 4% chance that the next child will also be affected
  • Not having enough folate in the diet during pregnancy also plays a significant role
  • Other risk factors include certain antiseizure drugs, obesity, and poorly controlled diabetes
  • It is a type of neural tube defect with other types including anencephaly and encephalocele
Classification
  • Spina bifida occulta, where the meninges do not herniate through the opening in the spinal canal. Rather, the spinous processes and the neural arch appear abnormal on a radiogram, but is generally harmless. Usually, the spinal cord and spinal nerves are not involved. It only rarely causes neurological Sx, causing no or only mild Sx. Sx may include a hairy patch, dimple, dark spot, or swelling on the back at the site of the gap in the spine. It is the most common
  • Spina bifida cystica, which both involves herniation of the meninges through the opening in the spinal canal. It includes:
    • ​Meningocele, which is less severe, does not involve herniation of the spinal cord, through the spinal canal opening. It typically causes mild problems with a sac of fluid present at the gap in the spine
    • Myelomeningocele (aka open spina bifida), which also involves herniation of the spinal cord through the spinal canal opening. It is the most significant form, leading to disbaility in most affected individuals. It is the most severe form

Patient information

How do you classify the incomplete closing of the hollow structures that become the brain and spinal cord?
So there's occulta and cystica. Cystica is where the meninges herniate through the opening in the spinal canal. Occulta is where the spinous processes and neural arch appear abnormal on an x-ray, but it's generally harmless.

What is the spinous process and neural arch?
Spinous process is a bony projection off the back of each vertebra. Neural arch is the back section of a vertebra, which encloses the canal through which the spinal cord passes through.

Cystica can be divided into 2 types?
Yeah. Meningocele and myelomeningocele. So meningocele is where there's just herniation of the meninges. And myelomeningocele is where there's herniation of both the meninges and spinal cord through the spinal canal.

Dx
  • Dx may occur either before or after a child is born
  • Before birth if a blood test or amniocentesis finds a high level of alpha-fetoprotein (AFP), there is a higher risk of spina bifida
  • U/S examination may also detect the problem
  • Medical imaging can confirm the Dx after birth
Tx
  • Can be surgically closed after birth, but doesn't restore normal function to the affected part of the spinal cord
  • Prevention, with incidence of spina bifida following a previous spina bifida birth, decreased by up to 70%, when the mother takes daily folic acid supplements, prior to conception. Most cases of spina bifida can be prevented if the mother gets enough folate before and during pregnancy. Adding folic acid to flour has been found to be effective for most women
  • Spina bifida is amongst the most common birth defect, with an incidence of 0.1%
See also

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Definition of Spina bifida | Autoprac


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