Stopping Spina Bifida
You just delivered your first child. But something is wrong. There is a soft spot at the base of your baby’s spinal cord and he has problems with his nerves. Your baby has spina bifida, explains the doctor.
Spina bifida is a birth defect where the spine and spinal cord don’t form properly. It is a type of neural tube defect. The neural tube is the structure in a developing embryo that eventually becomes the baby’s brain, spinal cord and the tissues that encloses them.
Usually the neural tube forms early in the pregnancy and closes the 28th day after conception. However, in babies with spina bifida, a portion of the neural tube doesn’t close or develop properly, causing problems in the spinal cord and in the bones of the spine.
The condition can be overwhelming and some types of spina bifida can be serious. But the condition can vary widely. Most cases are so mild that they have no symptoms and don’t need any treatment.
Infants born with a more serious type of this condition have open lesions on their spine where there is significant damage to the nerves and spinal cord. The opening can be repaired through surgery, but the nerve damage isn’t resolved and that causes permanent disability. Spina bifida can occur anywhere along the backbone, but is most often found in the small of the back or further down.
There are three types of spina bifida: spina bifida occulta, meningocele and myelomeningocele. Spina bifida occulta is the mildest and most common form of this condition. It usually only involves a minimal portion of the spine, it usually shows no symptoms and doesn’t require treatment. When an infant is born with spina bifida occulta, the skin covers the deformity of the spinal bone.
Spina bifida occulta means “a hidden spot on the spine” and for many people with this type of disorder it remains hidden. For some people, the skin overlying the defect will show some changes, such as a dimple, red or purple coloring or a tuft of hair.
In some instances, spina bifida occulta will cause problems as the child grows into adolescence. By this time in the child’s life, the spinal cord has become attached to the backbone. When the growth spurt of adolescence begins, the nerves of the spine become stretched. As a result, this can mean difficulties such as numbness and weakness in the legs, bladder infections and incontinence (lack of bladder and bowel control). Surgery to relieve these symptoms by reducing the tension on the spinal cord is simple and successful.
In the meningocele type of spina bifida, it is the least common type of this disorder, the meninges (the membrane surrounding the spinal cord) protrude through the opening causing a lump or a sac on the back. More severe than spina bifida occulta, meningocele can be repaired through surgery with little or no nerve damage resulting. The surgery is performed during infancy. With meningocele the spinal cord has developed normally and is undamaged. The child has no neurological problems.
Myelomeningocele is the most severe form of spina bifida. For infants with a myelomeningocele, the spinal cord doesn’t form properly and a portion of the undeveloped cord protrudes through the back. A sac of cerebrospinal fluid and blood vessels surrounds the protruding cord, which isn’t covered with skin, so that the nerves and tissues are exposed.
According to the Cleveland Clinic, between 70 and 90 percent of infants born with myelomeningocele also have hydrocephalus, due to a defect at the base of the skull. Hydrocephalus is the excess buildup of spinal fluid on the brain that can cause brain damage, seizures, or blindness if not treated. To avoid this, plastic shunts are surgically inserted beneath the skin to drain off excess fluid into the abdominal cavity.
Infants with myelomeningocele will have paralysis or weakness below the level of the spinal lesion. This affects the lower limbs along with problems with bladder and bowel function. In extreme cases, the trunk and upper extremities are involved.
Adults with spina bifida have different concerns than children with the disorder including
· Typical aging process including loss of muscle strength and flexibility, less physical stamina and a decrease in sensory abilities tend to decline faster or more severe for adults with spina bifida.
· Spinal cord tethering, where the spinal cord becomes attached to surrounding tissue that causes symptoms of skin sores, rapidly progressing scoliosis, loss of sensation, pain (especially in the lower extremities or testicles), urinary tract infections and leakage.
· Changes in bowel patterns including constipation or abdominal pain.
· Orthopedic issues such as osteoporosis, early onset of arthritis and progressive back pain.
· Loss of skin sensation as well as poor circulation, inability to sweat, bruising, slow wound healing
· Obstructive and central sleep apnea that can lead to long term damage to the heart.
· Adults with spina bifida tend to have high rates of obesity.
· Women with spina bifida can get pregnant, however their condition can make pregnancy more complex.
The cause of spina bifida is unknown. A combination of environmental factors and genetics may be the main cause.
Spina bifida can be detected during pregnancy but not always. Your doctor would order a blood test to see how much alpha-fetoprotein is in the blood. High levels indicate your fetus could have spina bifida. An ultrasound may provide imaging of the baby’s spine. An amniocentesis could test the fluid from the womb to check protein levels.
Treatment for spina bifida can range from surgery and physiotherapy to medication that may be needed during a patient’s life to prevent and manage certain complications.
Experts believe that certain precautions may be taken to prevent spina bifida such as the addition of folic acid to your diet. Women should take 400 mcg a day of folic acid. It can also be found in leafy green vegetables.
Spina bifida can range from mild to severe. With the right assistance, your child can lead a productive life. If you have questions about spina bifida, please talk with your health provider.
