Spina Bifida

Question 1

What is spina bifida?

Answer 1

• congenital neural tube defect
• most common in the lumbosacral area
• 1 to 2 cases per 1000 births
• cause may be genetic predisposition with essential nutrient deficiency (folic acid)

Question 2

What are the most common types of spina bifida?

Answer 2

1. spina bifida occulta = incomplete fusion of the posterior vertebral arch
2. meningocele = external protrusion of the meninges
3. myelomenigocele = protrusion of the meninges and spinal cord

Question 3

What are the clinical manifestations of spina bifida occulta?

Answer 3

1. dimple in the skin with tuft of hair

2. no neurological dysfunction

Question 4

What are the clinical manifestations of meningocele?

Answer 4

1. sacklike cyst protrudes outside the spine

2. usually no neuorlogic defects

Question 5

What are the clinical manifestations of myelomeningocele?

Answer 5

1. saclike cyst
2. permantne neurological impairment below level of involvement
3. flaccid or spastic paralysis
4. bowel and bladder incontinence
5. musculoskeletal deformities
6. hydrocephalus
7. sometimes mental retardation
8. perceptual difficulties
9. Arnold-Chiari malformation- large ventricles
10. defect in the formation of the brain stem
11. loss of sensation below level

Question 6

How is spina bifidia diagnosed?

Answer 6

1. prenatal US and serum alpha-fetoprotein test
2. postnatal examination
3. x-ray and CT scans

Question 7

What is the treatment for spina bifida?

Answer 7

1. surgical closure and removal of the sac
2. VP (ventriculoperitoneal) shunt of hydrocephalus
3. orthopedic sugeries
   - club feet very common
   - spinal fusions
4. bowel and bladder management
5. in utero closure of the sac (experimental)

Question 8

What is the prognosis for spina bifida?

Answer 8

• most deaths are before the age of 4 in severe cases
• survival to adulthood is 85%
• 2/3 children with myelmeningocele and hydorcephalus have normal intelligence
• other difficulties include: decreased hand function, decreased motor responses, decreased memory
• latex rubber allergies

Question 9

What are therapies for spina bifida?

Answer 9

• skin care b/c at risk for decubiti secondary to insensate (lacking physical sensation) skin
• strengthening
• adaptive equipment
• mobility
• AROM/PROM
• ADL’s