SPINA BIFIDA

National Institute of Neurol. Disorders and Stroke - NIH

Sam Lazuardi

SPINA BIFIDA SB - 1
Is a type of neural tube defect, which is a
problem with the spinal cord or its coverings
It happens it the fetal spinal cord doesnt
close completely during the 1st mo of
pregnancy
Usually there is nerve damage that causes
some paralysis of the legs need assisted
devices (braces, crutches or wheelchairs),
have learning difficulties, urinary & bowel
problems or hydrocephalus

SPINA BIFIDA SB - 2
There is no cure
Treatment focus on the complications
& include surgery, medicine and
physiotherapy
Taking folic acid can reduce the risk
of having a baby with Spina Bifida
SB occurs in various forms, each
varying in severity

SPINAD BIFIDA OCCULTA SBO

Mildest form results in a small gap in one
or more of the vertebrae of the spine
Spinal nerves arent involved -> no signs
or symptoms & no neurol problems
Visible indications of SBO can be seen on
the skin above the spinal defect : abn tuft
of hair, a collection of fat, a small dimple
of birthmark, skin discoloration
D/ X- ray

OTHER FORMS OF SB
Meningocele : the meninges around the spinal
cord push out through the opening in the vertebrae, because the spinal cord develops normally, the membranes can be removed by
surgery with little or no damage to the nerves.
Myelomeningocele : open SB, is the most
severe form : the spinal canal remains open
along several vertebrae, both the membrane
& spinal cord protrude forming a sac on the
back, tissues & nerves are exposed & prone to
life-threatening infections

MYELOMENINGOCELE
Neurological impairment is common,
incl :
Muscles weakness, sometimes
paralysis
Bowel & bladder problems
Seizures, especially if the child
requires a shunt
Orthopedic problems (deformed feet,
uneven hips and scoliosis)

RISK FACTORS
Race (more common among whites,
hispanics)
Family history of neural tube defects
Folate deficiency
Some medications : anti-seizure medication
(valproate)
Diabetes, who dont control the blood sugar
Obesity
Increased body temp (fever, sauna, hot tubs)

COMPLICATIONS
Physical & neurological problems :
lack of normal bowel-bladder control
& partial or complete paralysis of the
legs
Hydrocephalus
Meningitis
Other complications : learning
disabilities, latex allergies, skin
problems UTI, gastrointes-tinal
disorders & depression

TESTS AND DIAGNOSIS

Maternal serum alpha-fetoprotein
(MSAFP) test -> test for alphafetoprotein
USG if blood test indicates high AFP
levels
Amniocentesis when USG is N, but
high AFP -> look for AFP level in
amnion fluid

TREATMENTS AND DRUGS

Meningocele -> surgery to put meninges
back
Myelomeningocele -> surgery within 24 48
hrs after birth to minimize risk of infection
Hydrocephalus -> shunt
Prenatal surgery, before th 26th week of pregnancy - nerve function worsen rapidly after
birth
Cesarean birth (myelomeningocele with
breech position)

PREVENTION
All women of childbearing age to take 400
mcg folic acid daily, folic acid help also to
reduce other birth defects incl. cleft lip, cleft
palate and some congenital heart defects
Foods rich in folate : beans, citrus fruits, egg
yolks, dark green veggies (spinach, broccoli)
Higher dose 4000 mcg 4 mg, 1 mo before
conception 1st few mo of pregnancy if you
take anti-seizure medications, diabetes or
given birth to a child with SB