26. Spina Bifida

Question 1

Aetiology:

Answer 1

Neural tube defect present at birth. Deformity usually occurs in lower back. Cause is unknown.

Question 2

Risk factors

Answer 2

Family history of neural tube defects, increased body temp. in early weeks of pregnancy, obesity, poorly managed diabetes, folate deficiency, medications interfering with folate metabolism

Question 3

Diagnosis

Answer 3

Done prenatally, blood tests, ultrasounds

Question 4

Interventions

Answer 4

Prenatal surgery, postnatal surgery, urinary cauterisation, mobility aids.

Question 5

Prognosis

Answer 5

Depends on number and severity of abnormalities associated, personal and environmental factors.
Most: Normal intelligence, can walk with assistive devices.

Question 6

What are the three different types?

Answer 6

Spina bifida occulta
Spina bifida meningocele
Spina bifida myelomeningocele

Question 7

Spina bifida occulta

Answer 7

Most common, least severe. Malformation in one vertebrae, spinal cord and surrounding tissue don’t protrude. Prenatal tests don’t usually diagnose because tiny malformation.
Extensive spina bifida occulta: Foot deformity, leg weak ness, numbness or clumsiness, bladder/bowel dysfunction, hand weakness or numbness

Question 8

Spina bifida meningocele

Answer 8

Least common. Sac protruding from spinal column which contains CSF but no neural tissue. May be covered with skin or meninges. Spinal cord not damaged, only meninges slipping into gaps between deformed vertebrae.
Diagnosis: before birth ultrasounds, screening tests
Treatment: Surgery, closing overlying meninges under the skin, performed within 1-2 days of births to prevent infection and exposed area of spine.
Also EEA treatment, non-invasive, through nose.

Question 9

Spina bifida myelomeningocele

Answer 9

Most severe, low prevalence. Spinal cord develops outside of body, contained in fluid filled sac that bulges out from lower back (could be encapsulated with skin). Paralysis below sac.

Question 10

Symptoms and diagnosis of spina bifida myelomeningocele

Answer 10

Symptoms: Bowl and bladder incontinence, hydrocephalus, seizure, orthopaedic conditions.
Diagnosis: Prenatal blood work, amniocentesis, physical exam, MRI, ultrasound

Question 11

Treatment of spina bifida myelomeningocele

Answer 11

Surgery to close, decreases bulge by releasing excess fluids, restructuring position of the spinal and closing wound to protect spinal cord from surrounding nerves.
Done prenatal or post natal

Question 12

Co-occurring conditions

Answer 12

Arnold Chiari II malformation (Cerebellum and brain stem slips down into foramen magnum), Hydrocepahlus, tethered spinal cord (bottom of spinal cord floats freely in spinal canal. Cord stretched as person grows, resulting in nerve damage, back pain, scoliosis). Learning disabilities, latex allergies