Spina bifida (SB) is a neural tube defect (a disorder involving incomplete development of the brain, spinal cord, and/or their protective coverings) caused by the failure of the fetus's spine to close properly during the first month of pregnancy. Infants born with SB sometimes have an open lesion on their spine where significant damage to the nerves and spinal cord has occurred. Although the spinal opening can be surgically repaired shortly after birth, the nerve damage is permanent, resulting in varying degrees of paralysis of the lower limbs. Even when there is no lesion present there may be improperly formed or missing vertebrae and accompanying nerve damage. In addition to physical and mobility difficulties, most individuals have some form of learning disability.
Tethered cord and spina bifida
Pediatric neurosurgeon Stanley Skarli discusses tethered spinal cord syndrome and its link with spina bifida.
Types of spina bifida
- Myelomeningocele, the severest form, in which the spinal cord and its protective covering (the meninges) protrude from an opening in the spine.
- Meningocele in which the spinal cord develops normally but the meninges and spinal fluid) protrude from a spinal opening.
- Closed neural tube defects, which consist of a group of defects in which development of the spinal cord is affected by malformations of the fat, bone, or meninges.
- Occulta, the mildest form, in which one or more vertebrae are malformed and covered by a layer of skin. SB may also cause bowel and bladder complications, and many children with SB have hydrocephalus (excessive accumulation of cerebrospinal fluid in the brain).
The symptoms of spina bifida vary from person to person, depending on the type and level of involvement. Closed neural tube defects are often recognized early in life due to an abnormal tuft or clump of hair or a small dimple or birthmark on the skin at the site of the spinal malformation.
Meningocele and myelomeningocele generally involve a fluid-filled sac – visible on the back – protruding from the spinal canal. In meningocele, the sac may be covered by a thin layer of skin. In most cases of myelomeningocele, there is no layer of skin covering the sac and an area of abnormally developed spinal cord tissue is usually exposed.
Many children with SB have hydrocephalus (excessive accumulation of cerebrospinal fluid in the brain). Children with myelomeningocele often have issues with bladder and bowel control. They may also have difficulty moving their feet or legs, dependent on the level of involvement. In addition to physical and mobility difficulties, most individuals have some form of learning disability.
The prognosis for individuals with SB depends on the number and severity of abnormalities. Prognosis is poorest for those with complete paralysis, hydrocephalus, and other congenital defects. With proper care, most children with SB live well into adulthood.
There is no cure for SB because the nerve tissue cannot be replaced or repaired. Treatment for the variety of effects of SB may include surgery, medication, and rehabilitation. Pediatric physiatrists prescribe programs, therapies, medications, and equipment to help maximize recovery and function in an inpatient rehabilitation program, and throughout early adulthood.
Many individuals with SB will need assistive devices such as braces, crutches, or wheelchairs. Ongoing therapy, medical care, and/or surgical treatments may be necessary to prevent and manage complications throughout the individual's life. Surgery to close the newborn's spinal opening is generally performed within 24 hours after birth to minimize the risk of infection and to preserve existing function in the spinal cord.
NIH: National Institute of Neurological Disorders and Stroke