Spina Bifida: Symptoms, Causes, Treatment

Spina bifida is a congenital disability when the spinal cord doesn’t form properly. It falls into the broader category of neural tube defects. The neural tube is the embryonic structure that develops towards the baby’s spinal cord, brain, and tissues surrounding them.

Usually, the neural tube occurs early in pregnancy and closes entirely on the 28th day after conception. In babies with spina bifida, a section of the neural tube doesn’t develop properly or doesn’t close completely. This leads to damage to the spine and spine bones. This problem may be severe or mild, depending on the type, location, size, and complications of this problem. When early spina bifida is required, surgery is performed even if it doesn’t entirely resolve each condition.

What are Spina Bifida types?

Spina bifida is divided into different species. These;

  • Occulta: Occulta means hidden in words. Occultada, the lightest form of Spina bifida species, doesn’t have a neurological symptom or symptom in many patients. There may be a small birthmark or a small amount of hair on the skin with the spinal defect. Patients cannot know that they have this disease unless a test for another problem shows it by chance.
  • Meningocele: In the form of another spina bifida called meningocele, the protective membranes (known as meninges) around the spinal cord flow out of the opening in the spine to form a pouch filled with liquid. However, this pouch doesn’t cover the spinal cord, and therefore nerve damage is much lower. However, complications may occur at a later stage.
  • Myelomeningocele: Myelomeningocele, also called open this disease, is the most severe form of this problem. The spinal canal is open across several vertebrae in the middle or lower back. The spinal cord nerves and membranes pass through this opening during birth and form a sac in the baby’s back. In general, this situation reveals nerves and tissues. This action makes it more prone to infections that could threaten the baby’s body.
  • Closed Neural Tube Defects: In this form, there may be different potential problems in the bone, fat, or meninges of the spinal cord. In many cases, there is no indication. However, some patients may have partial paralysis, bowel disorders, and urinary incontinence.

What are the symptoms of Spina Bifida?

Signs and symptoms of spina bifida vary according to the severity and type of this problem. Also, symptoms may be different for each patient. Symptoms of spina bifida in general are;

  • Occulta: Since the spinal nerves aren’t generally included in this problem, there are no symptoms or signs. However, in some cases, visible symptoms may occur abnormally on the spinal defect in the baby’s skin, including hair, birthmark, and a small cup.
  • Meningocele: The membranes around the spinal cord leak out through an opening in the vertebrae. This creates a pouch filled with liquid. However, this pouch doesn’t include the spinal cord.
  • Myelomeningocele: In this most severe form of this problem, the spinal cord will remain open along several vertebrae in the middle or lower back. The spinal cord and the membranes or nerves will protrude during labor to form a sac. Nerves and tissues generally occur, and this skin covers the pouch in some cases.

What are the causes of Spina Bifida?

Experts aren’t sure which condition causes spina bifida. It is generally caused by a combination of environmental and genetic risk factors such as folate deficiency or family history, as is the case with many other problems.

Spina Bifida risk factors

Women with spina bifida are much more at risk than men. Although experts have not fully understood why spina bifida occurs, some risk factors trigger this problem. These;

  • Folate deficiency: Folate (vitamin B-9) is very important for the healthy development of infants. Folate is known as the natural form of vitamin B-9. Folate deficiency can increase the risk of this problems and other possible neural tube defects.
  • Family history: Couples who have a child with a neural tube defect will be more likely to have another baby suffering from the same problem. This risk situation increases if two previous children are affected by the crisis. However, a woman born with a neural tube defect will be more likely to give birth to a child with spina bifida.
  • Diabetes: Women with diabetes who cannot control blood sugar are likely to have a baby with spina bifida.
  • Obesity: Obesity before pregnancy is associated with an increased likelihood of neural tube congenital disabilities, including the problem of spina bifida.
  • High Body Temperature: According to some evidence, increased body temperature (known as hyperthermia) during the first weeks of pregnancy may increase the risk of this problem.

What problems does Spina Bifida cause?

This problem may cause minimal symptoms or only minor physical injuries. If spina bifida is severe, it may, in some cases, lead to more critical physical problems. Spina bifida can cause the following issues, but not always;

  • Gait and Movement Problems: The nerves that govern the leg muscles do not work correctly in the area with spina bifida. This causes weakening of the muscles in the legs, and in some cases, causes paralysis.
  • Orthopedic Problems: Children with myelomeningocele type may experience different problems in the spine and legs due to the weak muscles in the back and legs. The issues will generally depend on the level of the disease. Possible problems include an abnormal dislocation of the hip, curved spine (scoliosis), joint and bone deformities, muscle contractures, and other potential orthopedic concerns.
  • Bladder and Bowel Problems: The nerves that feed the bowel and bladder don’t work correctly when children have this type. This is because the nerves that provide the bladder and intestine come from the bottom of the spinal cord.
  • Accumulation of Fluid in the Brain (Hydrocephalus): Babies born with myelomeningocele type generally experience fluid accumulation in the brain, also known as hydrocephalus.
  • Chiari Malformation Type 2: This problem is a common brain abnormality in infants born with myelomeningocele form. In this problem, the brain stem is positioned much lower than usual. This may cause problems with swallowing and breathing. Rarely pressure can form in this area of ​​the brain, and surgery can reduce stress.
  • Infections in Tissues Surrounding the Brain (Meningitis): Some infants with myelomeningocele form may develop meningitis, acute infection in the tissues surrounding the brain. This life-threatening infection can cause brain damage.
  • Connected Spinal Cord: The connected spinal cord occurs when the spinal nerves are closed by surgical operations and connected to the scars, and the spinal cord grows much less as the baby grows. This progressive attachment can cause muscle function loss in the intestines, legs, or bladder. Surgical operations may limit the level of disability.
  • Sleep Disorders: Spina bifida, especially myelomeningocele form, can cause sleep disorders and sleep apnea in both infants and adults. In patients with myelomeningocele form, sleep disorders assessment helps identify sleep disorders to improve quality of life and overall body health.
  • Skin Problems: Children with spina bifida may have sores on their legs, feet, buttocks, and back. These wounds can cause significant infections.
  • Latex Allergy: Children with this problem may risk latex allergy or an allergic reaction to latex product types. Latex allergy can cause sneezing, skin rashes, itching, watery eyes, and runny nose. This can also lead to anaphylaxis.

In children with spina bifida, gastrointestinal diseases, urinary tract infections, and stress may develop with age.

Spina Bifida treatment

Spina bifida treatment generally depends on how severe the signs and symptoms are. In general, spina bifida treatment consists of;

Surgical operation

  • Spine repair surgery: This operation can be performed immediately after birth. Corrective procedures may be necessary if bone development problems such as dislocated joints or scoliosis occur later.
  • Prenatal Surgery: This operation is generally performed between 19 and 25 weeks of pregnancy. The doctor fixes the problem by repairing the spinal cord of the fetus.
  • Hydrocephalus: Surgical procedure treats the accumulation of spinal fluid in the brain.

Physical therapy

This treatment helps the patient become independent and prevents the weakening of the lower muscles. A specially developed leg will help keep muscles as strong as possible.

 

Resources:

https://pubmed.ncbi.nlm.nih.gov/27189655/

https://www.ncbi.nlm.nih.gov/books/NBK559265/

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