Spina bifida (open back, split vertebra) is a congenital disease from embryonic development that occurs in the first stages of pregnancy.
Spina bifida is caused by a closure disorder of the embryonic neural tube.
In this disease, the vertebrae do not form completely and lead to a neural tube opening.
The gap allows part of the spinal cord to exit through the unclosed bone part.
Spina bifida is a malformation that can be divided into four categories:
- Cystic or meningomyelocele
Often, occult spina bifida goes undiagnosed until a person has an X-ray of the back for another problem unrelated to spina bifida.
Even if this disorder of the spinal cord presents itself as harmless and does not affect the functioning of the body, it could cause other complications.
Causes of spina bifida
The defects of the neural tube (anencephaly and spina bifida) are caused by previously unexplained genetic and environmental factors.
The risk of spina bifida is about 1 in 800 pregnancies.
An insufficient intake of folate (folic acid) on the part of the mother during pregnancy increases the likelihood of having a child with spina bifida.The number of newborns with spina bifida has drastically decreased in recent years due to greater awareness of taking folic acid in the early stages of pregnancy.
Ultrasound and other examinations show the dysraphy and offer the mother the opportunity for an abortion.
There is a high risk of dorsal spina bifida in the following cases:
- Heredity, there is a genetic component
- Firstborn with spina bifida
- Taking antiepileptic drugs (such as valproic acid)
Signs and symptoms of spina bifida
Symptoms and consequences of spina bifida include:
1. Stiffness and back pain.
2. Pain and weakness in the legs.
3. Numbness of the legs up to the feet.
4. Sluggish intestine or constipation.
5. Anatomical malformation of back, legs and feet.
6. An abnormality at the end of the spinal cord can be identified by the aspect of the skin in the lower back.
The following are skin signs that indicate a lower occult spina bifida:
1. Hairy area on the lower back.
2. A red or purple dot on the skin indicates abnormal proliferation of blood vessels.
3. A small pit (called a sacred dimple) is present on the skin at the bottom of the back just above the hip.
4. A lighter area of skin compared to the surrounding zone.
5. Dark spots in the lumbar area of the back.
Complications of spina bifida
Below are the complications manifested in occult spina bifida:
1. Unification of the spinal cord: In this condition, the lower part of the spinal cord abnormally attaches to other structures surrounding the area. This leads to a prolonged and damaged spinal cord.
2. Thickening of the filum terminale: thickening of the end part of the spinal cord.
3. Diastematomyelia: This is a condition in which the spinal cord is divided into two parts due to a cartilage septum and bone.
4. Lipomeningomyelocele: A disease in which the spinal cord is present in a posterior cyst.
5. Fat in the filum terminale: Here there is a tumor or lump of adipose tissue at the end of the spine or in the surrounding tissue.
6. Spinal dermal sinus: A fistula or pit on the dorsal skin reaches the posterior part of the vertebra or dura mater; it forms at the level of the sacrum or coccyx.
7. More than half of children suffering from spina bifida develop an allergy to latex due to frequent contact with this substance.
Patients with spina bifida at the level of the vertebra S1 or below have no problems with infertility or impotence.
If the lesion is in a higher range, 50% of patients suffer from infertility.
Spina bifida above L2 causes erection problems.
Distinguishing features: diagnosis of spina bifida
About 90% of cases of spina bifida are diagnosed by prenatal ultrasound of the fetus during the first 18 weeks of pregnancy.
- maternal blood tests and amniocentesis measure alphafetoprotein (AFP),
- Magnetic resonance imaging (MRI).
Treatment for spina bifida
There is no therapy to cure spina bifida.
In open spina bifida, the nerves and spinal cord are exposed.
It is important to close the skin and muscle defect in the first days of life to avoid a number of complications:
- Spinal cord damage
Folic acid prevents spina bifida.
Folic acid is a vitamin of the B group. The recommended dose of folic acid prevents the majority of neural tube defects.
Folic acid should be taken daily: one month before fertilization and during the first three months of pregnancy.
The National Health and Medical Research Council recommends that all women who are planning to become pregnant or who expect to become pregnant take 0.4mg of folic acid daily.
People at high risk should take a higher dose.
Treatment options include:
- Surgical intervention: The lesion is closed, thus reducing the risk of infection.
- Insertion of a shunt: Hydrocephalus is treated by inserting a valve and a tube (called a shunt) into the ventricles of the brain, where the cerebrospinal fluid forms. The shunt allows the cerebrospinal fluid to drain from the brain into the abdomen.
- Orthopedic surgery: Children with spina bifida undergo surgery on their legs and feet to improve mobility.
- Aids to increase mobility: Walking aids or wheelchairs allow the child to move.
- Rehabilitation can help the patient reduce stiffness and pain and improve circulation.
Spina bifida occulta
Misconceptions about spina bifida
Myth → Children born with spina bifida are stillborn or do not survive their childhood.
Fact → The probability of stillbirth due to spina bifida is less than 5%. This includes children born with other body defects, such as heart problems. The second problem could increase the death rate.
Myth → The position of spina bifida along the spine determines life expectancy.
Fact → The position of spina bifida does not affect life expectancy.
She points out how pronounced the paralysis of the legs and feet will be.
The paralysis is below the level of the lesion, so the higher the location, the worse the clinical findings.
Myth → If a child has spina bifida and hydrocephalus (hydrocephalus), the prognosis (life expectancy) is short.
Fact → Most children born with spina bifida develop hydrocephalus during pregnancy or immediately after birth.
The only difference is in treatment: most children with hydrocephalus are treated with a shunt.
The presence or absence of hydrocephalus does not affect life expectancy.
How long do you live? Life value expectancy of a child with spina bifida
A study published in 2001 looked at survival rates among children with spina bifida born between 1975 and 1979.
In the group of about 118 children, 76% of those affected by spina bifida reached adulthood (20-25 years).
The most common cause of death is an unknown problem with the functioning of the shunt.
Today, it can be said that most children born with spina bifida survive to adulthood.
It has been found that 90% of people born with dysraphy live beyond the third decade of life, while other experts believe that this condition does not affect life expectancy in any way.
However, no definitive statements can be made as the studies are still very new, are still being updated and are incomplete in terms of life expectancy.