SPINA BIFIDA

This is a condition that results from a development detect

in the vertebral column resulting in a lack of fusion of the
vertebral arches and so the vertebral canal is not closed.
There may or may not be detects of the spinal cord and
meninges, and in some cases there are little or no
symptoms.
Pathology
There are two main types of this abnormality, spina bifida
occulta and spina bifida cystica.
Spina Bifida Occulta
This is the mildest form of the defect and is observed in
only a small percentage of children with spina bifida. Ihe
actual number may be larger because there may not be
any obvious detect or abnormality externaly. Ihere 1S a
defect in the fusion of the laminal arch but this may only be
evident on X-ray. There is a dimple in the skin over the
vertebrae, and sometimes there may be small
fuft of hair over the area. A common feature of this type of
lesion is abnormality of bladder control with either enuresis
or urine retention.
Spina Bifida Cystica
Meningocele: The vertebral arch is not fused and a sac
containing meninges and cerebrospinal fluid protrudes out.
Myelomeningocele this is the most severe form of spina
bifida and inevitably there 1s neurological damage.
Depending on the level of the lesion,
the protruding sac contains part ot the spinal cord or the
cauda equina.
Because the cerebrospinal fluid does not flow properly due
to the obstruction,over S0% of children with this disorder
have an associated hydrocephalus.
CLINIVAL FEATURES
There is an obvious lesion over the vertebral detect on the
back.
Muscle paralysis or weakness- This will depend on the
levels and the extentextent the lesion. it the uPper motor
neurons are afected there may bea spastic
paraplegia; otherwise there is a flaccid paralysis.
Sensory impairment can be variable depending on the
extent and level of the lesion.
Rectal and/ or bladder incontinence (neurogenic bladder)
is very often a troublesome complaint and the parents find
it very difticult to send the child to school because of the
continuous need tor sanitary pads.
Hydrocephalus may be an associated problem.
Other congenital abnormalities of the lower limbs or spine
(spina bifida or CDH) may be present.
Mental retardation is not very common but could be
present.
MANAGEMENT
The management is not unlike that of paraplegia.
Surgery may be necessary to repair the spinal detect and
prevent further damage
Counseling of parents: Counseling and support for the
family is an important aspect of management.
Education: Integration into a normal school is the goal
whenever possible, but it must be atter a caretul
assessment ot the child to see whether he will
be able to cope with the various aspects ot School life.
Physiotherapy: The problems that the physiotherapist may
have to deal with are lack of movementor abnormal
movement patterns. ln addition, there are
detormities, anesthesia over buttocks and heels, and
psychological problems.
The physiotherapist will try to prevent detormities from
occurring by correct positioning and teaching parents.
Passive movements will be carried out to prevent
contractures.
Psychological problems: There may be frustration,
depression, irritability or anger. If the reactions are severe
the child may need help from a clinical psychologist or
trom an educational psychologist if there are learning
Functional activities: All treatment is designed to gain as
much functional activity as possible. The physiotherapist
must work with other members of the team, the child and
the parents to achieve this.
Orthosis: may be designed to train the patient's gait