Spina Bifida

Spina Bifida

Spina Bifida

Refers to a malformation of the spine I which the posterior portion of the laminae of the vertebrae fails to close.

Several types of spina bifida are recognized as these are:

1- ٍSpina bifida occult: the defect is only the vertebrae, the spinal cord and meninges are normal, not visible externally.

With growth, the child may develop foot weakness or bowel and sphincter disturbances.

2-meningocele: consists of a saclike cyst of meninges filled with spinal fluid but involves no nerves or neurological defects. the cyst is usually covered with skin. the defect may occur anywhere on the cord " usually from the thorax and up". surgical correction is necessary to prevent rupture of the sac and subsequent infection. hydrocephalus may be an associated finding.

3- meningomyelocele: " the most common type " is a hernial protrusion of a sac-like cyst of meninges, spinal fluid a portion of the spinal cord with its nerves through a bony defect in the vertebral column. the cyst is covered with a thin membrane. the sac may leak in the uterus or may rupture after birth allows free drainage of CSF, so the child is susceptible to meningitis . in absence of treatment, the child mostly dies.

Aetiology:

- Unknown.

- Genetic predisposition.

- Environmental.

Associated problems:

1- Loss of motor control and sensation below the level of the lesion.

2- Contractures may occur in the ankles, knee and hips.

3- Clubfeet, CDH are a common accompanying anomaly.

4- Incontinence, susceptibility to UTI because of constant urinary stasis.

5- Faecal incontinence and constipation.

6- Overweight.

Prevention:

Increase intake of folic acid.

Prenatal detection is now possible through amniocentesis and measurement of alpha-fetoprotein.

Surgical interventions: Laminectomy " usually at birth".


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