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Spina Bifida
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Spina bifida is one type of neural tube defect that a baby can be born with. The neural tube is the embryonic tube that encases the infant brain and spinal cord, including the bones of the skull and the vertebrae. The neural tube usually closes about twenty eight days after conception. If a baby has spina bifida, the base of the neural tube fails to close, exposing the spinal cord and causing several nervous system problems.
Spina bifida comes in three major forms. Some are severe and others are minor. From less severe to more severe are the following:
- Spina Bifida Occulta is a separation or space that separates the two sides of the vertebrae in the lower spine. The spinal nerves remain intact and sometimes it is only found on x-ray or by noticing a tuft of hair or a small dimple in the baby's back near the buttocks. There are generally no symptoms from this disorder.
- A Meningocele is relatively rare. It involves an outpocketing of the meninges in the lower spine. The vertebrae are not complete but the spinal cord is normal. Surgery can fix this problem without difficulty.
- In a myelomeningocele, also called "open spina bifida", the spinal cord is exposed and the vertebrae are open to the outside. Skin may or may not cover the sac of tissue. There is usually paralysis of the spine that lasts a lifetime. Surgery must be done to cover the spine and surrounding tissues.
Doctors don't know what causes spina bifida but it is known that a lack of folic acid in the maternal bloodstream due to deficiency can cause this. It is also a condition that can run in families.
Risk factors for spina bifida include being white or Hispanic, having a family history of neural tube defects, having folate or folic acid deficiency, or taking medications like Depakote for seizure disorders. Diabetics in poor control have an increased risk for spina bifida in their babies. Maternal obesity is related to spina bifida and a fever during early pregnancy (or exposure to tanning beds or saunas) can contribute to the risk of spina bifida.
The severity of spina bifida depends on the size of the neural tube defect and it depends on the location of the neural tube defect. If skin covers the hole, it is better than if it doesn't cover the hole. The spinal cord nerves involved also affect the severity of the disease.
Complications of physical and neurological problems include lack of bowel and bladder control, paralysis of the lower extremities, hydrocephalus, and meningitis (if skin does not cover the defect). Learning defects can occur as well as bladder infections, stomach problems and depression.
Screening for spina bifida can occur in pregnancy. There are blood tests that can define a risk for spina bifida and an ultrasound can sometimes pick up a meningomyelocele or a meningocele. The blood test is for an alpha fetoprotein level in the maternal serum. If it abnormally high, there can be spina bifida, among other things. It is not a very specific test for spina bifida and many other things can cause a high level of alpha fetoprotein. The MSAFP (maternal serum alpha fetoprotein) level is often done along with a human chorionic gonadotropin level, an inhibin A level and an estriol level in a "quad screen" for neural tube defects and things like trisomy 21, also called Down syndrome.
A good ultrasound can pick up on spina bifida. It is done if the AFP level is high. The images can show defects in the spine and can determine the gestational age, which can throw off the AFP level. The open spine can be seen if the ultrasound is an advanced one.
An amniocentesis can also show high AFP levels. This is the most accurate screening test for spina bifida and can show the disease if the ultrasound is not effective in defining spina bifida.
The treatment of spina bifida depends on the severity of the disease. Spina bifida occulta requires not treatment. Others require surgery to put the meninges back into the vertebra and close the defect in the skin or in the vertebrae. Myelomeningoceles require immediate surgery soon after birth. This can minimize nerve damage and can cover the defect with skin so meningitis doesn't occur. A shunt to control hydrocephalus is also placed shortly after birth.
Those with symptomatic spina bifida need ongoing medical care including physical therapy, surgical treatment and treatment of complications. They usually need to be delivered via cesarean birth because the meningocele can't always fit easily through the birth canal and the baby can get stuck. The meningocele can be damaged as well. In rare conditions, prenatal surgery is done to fix the spinal defect while the baby is still in the womb.