What Is Spina Bifida?
Spina bifida is a birth defect that mainly affects the spine. Normally in the first month of pregnancy, a special set of cells forms the “neural tube.” The top of the tube becomes the brain and the remainder becomes the spinal cord and structures around it. Spina Bifida is the most common permanently disabling birth defect that is associated with life in the United States. It’s a type of neural tube defect (NTD) that occurs when a babies neural tube fails to develop or close properly – the literal meaning for Spina Bifida is “split spine”.Estimated Reading Time: 4 mins.
Health issues are different for each person with spina bifida. Open spina bifida myelomeningocele —in which the spinal cord is exposed—tends to cause more severe problems. Many infants born with spina bifida get extra fluid in and around the brain, a condition called hydrocephalus, or water on the brain. The extra fluid can cause swelling of the head, which may lead to brain injury. The brains of most children with open spina bifida are positioned abnormally. The lower part of the brain rests farther down than normal, partially in the upper spinal canal.
While most affected children have no other symptoms, a few may have upper body weakness and trouble breathing and swallowing. Typically, the bottom of the spinal cord floats freely in the spinal canal, but for many people with spina bifida, the spinal cord is attached to the spinal canal. Thus, the spinal cord stretches as a person grows, and this stretching can cause spinal nerve damage.
The person might have back pain, scoliosis crooked spine, pronounced skoh-lee-OH-sisweakness in the legs and feet, bladder or bowel control problems, and other issues. People what butler creek covers what scopes spina bifida high on the back near the head, for instance might not be able to move their legs.
People with spina bifida low on the back near the hips, for example might have some leg mobility and be able to walk unassisted or with crutches, braces, or walkers. People with spina bifida often cannot control their bladder and bowel movements. They also can develop urinary tract infections. Many people with spina bifida—possibly three-quarters of those with what is spina bifida associated with condition—are allergic to latex, or natural rubber.
Some people with open spina bifida have additional physical and psychological conditions, including digestive, vision, sexual, social, and emotional problems; obesity; and depression. Chiari II Malformation The brains of most children with open spina bifida are positioned abnormally. Tethered Spinal Cord Typically, the bottom of the spinal cord floats freely in the spinal canal, but for many people with spina bifida, the spinal cord is attached to the spinal canal.
Paralysis, Mobility Limitations People with spina bifida high on the back near the head, for instance might not be able to move their legs. Lack of Bladder and Bowel Control People with spina bifida often cannot control their bladder and bowel movements. Latex Allergy Many people with spina bifida—possibly three-quarters of those with the condition—are allergic to latex, or natural rubber. Spina bifida: Health issues and treatments. Latex natural rubber allergy in spina bifida.
Birth defects. What are the treatments?
Can Spina Bifida Be Detected Before Birth?
What Is Spina Bifida? Spina Bifida is the most common permanently disabling birth defect that is associated with life in the United States. It’s a type of neural tube defect (NTD) that occurs when a baby’s neural tube fails to develop or close properly – the literal meaning for Spina Bifida is “split spine”.Estimated Reading Time: 4 mins. Mar 30, · Tethered Spinal Cord Typically, the bottom of the spinal cord floats freely in the spinal canal, but for many people with spina bifida, the spinal cord is attached to the spinal canal. Thus, the spinal cord stretches as a person grows, and this stretching can cause spinal nerve damage.
What is spina bifida? What are the types of spina bifida? How does folic acid help? How is spina bifida diagnosed? How is spina bifida treated? What research is being done? How can I help with research? Where can I get more information? Spina bifida is a birth defect that mainly affects the spine. Often, abnormalities of the brain such as hydrocephalus , described below accompany abnormalities of the spine because the neural tube closes first in the middle and then closure proceeds both upward and downward—meaning that if something happens that prevents normal formation of the spine, it may also prevent normal formation of the part of the brain that is forming closing at the same time.
The term neural tube defect describes a group of conditions, including spina bifida, that occur when the neural tube does not close all the way. Each year approximately 1, babies born in the United States have spina bifida, according to the U. Centers for Disease Control and Prevention. The exact cause of spina bifida is unknown.
There is no cure but most people with spina bifida lead long and productive lives. Scientists suspect genetic, nutritional, and environmental factors all play a role in spina bifida. People with spina bifida have different abilities and medical issues. There are four types of spina bifida: occulta, closed neural tube defects, meningocele, and myelomeningocele. The symptoms of spina bifida vary from person to person, depending on the type and level of involvement. Folic acid, also called folate, is an important vitamin for the development of a healthy fetus.
Although taking this vitamin cannot guarantee having a healthy baby, it can help. Studies show that women of childbearing age who add folic acid to their diets can significantly reduce the risk of having a child with a neural tube defect. Therefore, it is recommended that all women of childbearing age take a daily vitamin supplement with micrograms of folic acid before and during early pregnancy.
Foods high in folic acid include dark green vegetables, egg yolks, and some fruits. Many foods—such as some breakfast cereals, enriched breads, flours, pastas, rice, and other grain products—are now fortified with folic acid. Many multivitamins contain the recommended dosage of folic acid as well. Women who already have a child with spina bifida, who have spina bifida themselves, or who have already had a pregnancy affected by any neural tube defect are at greater risk of having another child with a neural tube defect.
These women should take a higher prescription dose of folic acid before and early in pregnancy. In most cases, spina bifida is diagnosed before birth prenatal. However, some mild cases may go unnoticed until after birth postnatal. Very mild forms of spinal bifida are found when doing tests for other conditions or may never be detected. The most common screening methods used to look for spina bifida during pregnancy are maternal serum alpha fetoprotein MSAFP screening and fetal ultrasound.
A doctor can also perform an amniocentesis test. The second trimester MSAFP screen may be performed alone or as part of a larger, multiple-marker screen. Multiple-marker screens can look for neural tube defects and other birth defects, including Down syndrome and other chromosomal abnormalities.
First trimester screens for chromosomal abnormalities also exist but signs of spina bifida are not evident until the second trimester when the MSAFP screening is performed. Closed neural tube defects are often recognized at birth due to an abnormal fatty mass, tuft or clump of hair, or a small dimple or birthmark on the skin at the site of the spinal malformation.
Spina bifida occulta is usually found when x-rays are done for another reason. In rare cases, myelomeningocele and meningocele are not diagnosed during routine prenatal tests. The baby will be diagnosed when they are born with a bubble on their back. Babies with myelomeningocele and closed neural tube defects may have muscle weakness in their feet, hips, and legs that result in joint deformities first noticed at birth.
Mild cases of spina bifida occulta, closed neural tube defects not diagnosed during prenatal testing may be detected postnatally using ultrasound or X-ray imaging to look at the spine.
Doctors may use magnetic resonance imaging MRI or a computed tomography CT scan to get a clearer view of the spinal cord and vertebrae. To evaluate for hydrocephalus , the doctor will request a head ultrasound, CT or MRI to look for extra cerebrospinal fluid inside the brain.
Treatment depends on the type of spina bifida a person has. Myelomeningocele and meningocele require a surgery to close the bubble shortly after birth to prevent infection such as meningitis. Most people with myelomeningocele have hydrocephalus and most of them will need a shunt placed as an infant. Children with a closed neural tube defect may need surgery to prevent further complications such as weakness and bowel and bladder function.
Generally, people with spina bifida occulta will not need any treatment. The Management of Myelomeningocele Study MOMS showed that prenatal surgery to close the defect in the spinal cord improved outcomes compared to children who had postnatal surgery for spina bifida. Data from the study showed that prenatal surgery reduced the need to drain fluid from the brain, improved mobility, and increased the chances that a child will be able to walk independently early on.
The procedure does not restore lost neurological function that happened before the surgery, but may prevent additional damage from occurring during the rest of the pregnancy. Although prenatal surgery poses some risk to the fetus as well as to the mother, the benefits are promising and are still being studied. In treating myelomeningocele and meningocele, the key priorities are to prevent infection from developing in the exposed nerves and spinal cord through the spinal defect, and to protect the exposed nerves and spinal cord from additional trauma.
Therefore, a child born with these types of spina bifida who has not undergone prenatal surgery will have surgery to close the defect and minimize the risk of infection or further trauma within the first few days of life.
Some children with myelomeningocele and closed neural tube defects will need surgery to improve the alignment of their feet, legs, or spine. Children with myelomeningocele usually have hydrocephalus and may require surgery to help drain fluid in the brain, such as the placement of a shunt or ETV.
Multiple surgeries may be required to replace the shunt, which may become clogged, infected, or disconnected. Some individuals with myelomeningocele or closed neural tube defects require assistive devices for mobility such as braces, walkers, crutches, or wheelchairs. The location of the defect on the spine often determines the type of assistive devices needed.
Children with a defect high on the spine will have little movement of the legs and will use a wheelchair for mobility. Children with a defect lower on the spine usually have more strength in the legs. They may be able to walk independently, or they may use crutches, leg braces, walkers, and wheelchairs depending on the activity. Children with myelomeningocele usually have some degree of delayed mobility, so they are referred to physical therapists early on to maximize their strength and function.
Treatment for bladder and bowel dysfunction typically begins soon after birth. Children with myelomeningocele and some closed neural tube defects have damage to the lowest spinal nerves which control typical bowel and bladder function. Some children may be able to urinate typically, but most will need to drain their bladders with a catheter or thin tube times a day to remain dry in between and to prevent kidney damage. Kidneys are monitored closely so that medications or surgeries can be performed to prevent renal failure.
To prevent bowel accidents many people with myelomeningocele and closed neural type defects will use rectal medications or large volume enemas to have planned bowel movements. Close follow-up with a spina bifida specialty clinic is recommended to develop a safe bowel and bladder program.
Treatment for progressive tethering of the spinal cord called tethered cord syndrome can be treated with surgery to help prevent further neurological deterioration. Genetic studies. In one study supported by NINDS , scientists are looking at the hereditary basis of neural tube defects and hope to find the genetic factors that make some children more likely to have a neural tube defect.
These researchers are also studying gene expression during the process of normal neural tube closure, which will provide information on the human nervous system during development. Findings may lead to ways to prevent these disorders.
In addition, NINDS-supported scientists are working to identify, characterize, and evaluate genes involved in neural tube defects. The goal is to understand the genetics of neural tube closure and to develop information that will lead to improved clinical care, treatment, and genetic counseling. Other scientists are studying genetic risk factors for spina bifida, especially those that reduce the effectiveness of folic acid in preventing spina bifida.
This study will shed light on how folic acid prevents spina bifida and may lead to improved forms of folate supplements. Developmental studies. NINDS supports and conducts a wide range of basic research studies to understand how the brain and nervous system develop.
These studies contribute to a greater understanding of neural tube defects such as spina bifida and offer hope for new ways to treat and potentially prevent these disorders as well as other birth defects. Because fetal surgery has shown promise, NINDS-funded researchers are also developing new methods, such as stem cell patches and tissue engineering, to add to the prenatal repair of spinal defects. Other NIH research efforts. Consider joining a clinical study. Both healthy individuals and those with a disease or condition can participate in medical research studies sometimes called clinical trials or protocols to help researchers better understand a disease and perhaps develop new treatments.
Box Bethesda, MD NIH Publication No. Back to Spina Bifida Information Page. NINDS health-related material is provided for information purposes only and does not necessarily represent endorsement by or an official position of the National Institute of Neurological Disorders and Stroke or any other Federal agency. Advice on the treatment or care of an individual patient should be obtained through consultation with a physician who has examined that patient or is familiar with that patient's medical history.
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