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Spina Bifida

At Hopkins Children’s, the Divisions of OrthopedicsNeurology and Neurosurgery treat Spina Bifida.

What is Spina Bifida?

Spina Bifida, or myelomeningocele, one of the most common birth defects of the central nervous system, is a neural tube defect in which the bones of the spine do not completely form, resulting in an incomplete spinal canal. This causes the spinal cord and meninges (the tissues covering the spinal cord) to stick out of the child's back. The cause of Spina Bifida is unknown, but folic acid deficiency is thought to play a part. Also, if a child is born with Spina Bifida, subsequent children in that family have a higher risk than the general population. 

Symptoms

A newborn may have – 

  • A sac sticking out of the mid to lower back 
  • Loss of bladder or bowel control 
  • Partial or complete lack of sensation 
  • Partial or complete paralysis of the legs 
  • Weakness of the hips, legs, or feet of a newborn 

Prevention

Folic acid supplements may help reduce the risk of neural tube defects such as Spina Bifida. It is important to remember that folic acid deficiencies must be corrected before becoming pregnant as the defects develop very early. Prospective mothers may be screened to determine the amount of folic acid in their blood.  

Diagnosis

During the first trimester, pregnant women can have a triple screen blood test for Spina Bifida, Down syndrome, and other congenital diseases in the baby. Most women carrying a baby with spina Bifida will have a higher-than-normal levels of a protein called maternal alpha fetoprotein (AFP). If the triple screen is positive, further testing is needed to confirm the diagnosis, including ultrasound and amniocentesis. After birth, a neurologic examination may show that the child has loss of nerve-related functions below the defect. How the infant responds to pinpricks at various locations may reveal where he or she can feel the sensations. Other tests after birth may include X-rays, ultrasound, CT, or MRI of the spinal area. 

How to Treat Spina Bifida

Genetic counseling may be recommended. In some cases where severe defect is detected early in the pregnancy, a therapeutic abortion may be considered. After birth, surgery to repair the defect is usually recommended at an early age. Before surgery, the infant must be handled carefully to reduce damage to the exposed spinal cord. Antibiotics may be used to treat or prevent infections such as meningitis or urinary tract infections. Bowel training programs and a high fiber diet may improve bowel function. Orthopedic or physical therapy may be needed to treat musculoskeletal symptoms. Neurological losses are treated according to the type and severity of function loss. 

A Spina Bifida can usually be surgically corrected. With treatment, length of life is not severely affected, but neurological damage is often irreversible. 

External Links:

Spina Bifida Association  

Association for Spina Bifida and Hydrocephalus 

National Institutes of Health