Definition and Overview

Spina bifida is a neural tube defect that occurs at birth. It affects a baby when the spinal bones do not properly form around a certain part of the spinal cord, causing the spine to be exposed at some point. This condition can occur in mild and severe forms. In the milder form, which is most common, the exposed spine is marked simply by a birthmark, dimple, or a hairy patch at the back. Mild cases of spina bifida do not require treatment and do not cause major problems, allowing the patient to live a normal life.

More severe forms of spina bifida also go by the name of meningocele. In such cases, the spine pushes against the skin, as signified by a bulge, and some fluid may leak out of it. The most severe form, which is known as myelomeningocele, is when the spinal nerves are damaged or are pushing out through the spinal canal, causing an opening in the skin with the nerves fully exposed. Sometimes, the affected children also have brain problems that may hinder them from having a normal life.

Causes

There is no known and definite cause for spina bifida, but experts are leaning towards genetic combined with environmental factors. Studies show that a woman who has given birth to a baby with spina bifida faces a higher risk of having another baby with the same birth defect. Also, women who are not in a good state of health, such as those suffering from chronic diseases like diabetes or those who are obese, are more likely to give birth to babies with birth defects.

Key Symptoms

While cases where bulges and hairy patches at the back are more noticeable and are easier to diagnose, milder cases with no definite marks are harder to recognize as spina bifida. Thus, a complete and thorough examination is necessary to check for other symptoms that point to this neural tube defect. Sometimes, the condition can be diagnosed before birth, with the help of an ultrasound scan and an amniocentesis, but sometimes, it can only be fully diagnosed when the baby is older so that other symptoms may be observed.

Other symptoms associated with spina bifida include:

  • Little to no feeling in the arms, legs, or feet, or in one arm, one leg, or one foot
  • Restricted movement in the affected limb
  • Bowel problems or difficulty passing stools
  • Bladder problems or leaking urine
  • Hydrocephalus, or fluid building up in the brain; this may also increase the risk of seizures, vision problems, and learning disabilities
  • Scoliosis or a curved spine

An x-ray, MRI, or CT scan are also used nowadays to confirm spina bifida diagnosis and to determine the severity of the condition.

Types of treatment available

In milder cases, spina bifida sufferers can live long full lives without requiring any treatment. Some cases of meningocele may not need treatment as well. However, all patients affected with myelomeningocele should receive continuous treatment due to the complications posed by their condition. In the most severe forms of the condition, surgery may also be an option. In fact, such surgery can be performed even before birth.

Specific symptoms may also receive separate treatment. For example, a child with hydrocephalus may require surgery to drain out the excess fluid in the head, while a child with scoliosis may receive a back brace or other therapeutic aids to help reduce the spinal curvature. Patients who also experience bladder problems may also get a catheter to help prevent kidney damage, while those who have bowel problems should receive bowel management aid once the baby starts eating solid food. Since some symptoms may arise only when the child is older, other treatments and surgeries may be required later on.

Some spina bifida sufferers may also need long-term therapy from physical and occupational therapists so they will learn how to perform activities normally. Regular exercises during therapy also help keep the patient active throughout life. Therapy, however, should begin soon after the child is born.

Children and even grownups with spina bifida may also experience problems with their self-esteem, especially when the effects of their condition are physically visible. It is important for the patients’ family to help them build self-esteem in a lifelong process that begins in childhood. The child should feel that he belongs and should thus be treated as normally as possible.

When to see specialists for spina bifida treatment

Spina bifida is treated by a group of specialists including a pediatrician, an obstetrician (for pre-natal repairs), an orthopedist, a physical therapist, and an occupational therapist.

Since some signs of spina bifida will be noticeable at birth, medical attention is usually promptly provided to the affected baby. However, if no initial signs of the defect show at birth, parents should take their baby to the doctor if they observe any of the above symptoms in their child.

Also, the best way for a parent to help a child with spina bifida is to seek proper help, consider the pros and cons of all possible treatment options including surgery, go to all scheduled visits to the doctor, and encourage the child to be active and independent.

How it can be prevented

This neural tube defect, which initially occurs inside the womb, can be prevented during pregnancy. During this crucial stage, a woman should make sure to get plenty of folic acid. Although a lot of food products nowadays have folic acid added, obstetricians may prescribe folic acid supplements to make sure the pregnant mother is getting enough and to help reduce the risk of birth defects. While the average adult needs a normal dose of 400 mcg of folic acid, a pregnant woman should get at least 600 mcg. Women of childbearing age are also advised to keep their folic acid levels between 400 and 800 mcg.

It is also advisable for pregnant women to stop taking other medications and refrain from drinking alcohol during their pregnancy as both activities can cause birth defects.

It is also important to regulate the body temperature of a pregnant woman, especially during the early stages of pregnancy when the baby is still developing. During the first weeks of pregnancy, high temperatures should be avoided, so it is important to steer clear of saunas and hot tubs and to treat high fever immediately. Heightened temperatures during the first weeks of pregnancy, during which the spinal cord is formed, may raise a baby’s risk of getting spina bifida.

References:

  • Fletcher J., Brei T. (2010). “Spina Bifida – A Multidisciplinary Perspective.” Developmental Disabilities Research Reviews.
  • Fieggen G., Fieggen K., Stewart C., Padayachy L. et al. (2014). “Spina Bifida: A Multidisciplinary Perspective on a Many-Faceted Condition.” South African Medical Journal.
  • Thom E., Spong C., Brock J. et al. (2011). “A Randomized Trial of Prenatal versus Postnatal Repair of Meningocele.” The New England Journal of Medicine.
  • Kennedy D. (1998). “Spina Bifida.” The Medical Journal of Australia.
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