Spina bifida- Meylomeningocele CAT

Question 1

What is spina bifida?

Answer 1

• A congenital neural tube defect that generally occurs in the lumbar spine
• Can occur at the sacral, cervical, and thoracic levels

Question 2

Classifications of spina bifida

Answer 2

• spina bifida occulta
• spina bifida meningocele
• spina bifida myelomeningocele

Question 3

spina bifida occulta

Answer 3

Incomplete fusion of the posterior vertebral arch w/ no neural tissue protruding

Question 4

spina bifida meningocele

Answer 4

Incomplete fusion of the posterior vertebral arch w/ neural tissue/meninges protruding outside the neural arch

Question 5

spina bifida myelomeningocele

Answer 5

Incomplete fusion of the posterior vertebral arch w/ both meninges and spinal cord protruding outside the neural arch

Question 6

Characteristics of spina bifida myelomeningocele

Answer 6

• Sac or cyst that protrudes outside the spine
• Contain a herniation of meninges, CSF, and spinal cord through the defect in the vertebrae

Question 7

What percentage of vertebral defects are found in the lumbosacral region?

Answer 7

75%, typically w/ L5-S1 injury to the structures

Question 8

Contributing factors for spina bifida myelomeningocele

Answer 8

• Genetic predisposition
• Environmental influence
• Insulin-dependent diabetes
• Low levels of maternal folic acid, alcohol, maternal hyperthermia, certain classes of drugs

Question 9

Clinical presentation for spina bifida myelomeningocele

Answer 9

• Sac on the back
• Motor and sensory loss below the defect
• Hydrocephalus
• Arnold-Chiari type II malformation
• Clubfoot
• Scoliosis
• Bowel and bladder dysfunction
• Learning disabilities

Question 10

Most common treatment for spina bifida myelomeningocele

Answer 10

• Surgical intervention to close the lesion
• Shunt for hydrocephalus

Question 11

Intelligence and spina bifida myelomeningocele

Answer 11

• 2/3 have normal intelligence
• 1/3 only mild intellectual disabilities
• Difficulties w/ perception, attention, problem solving, and memory

Question 12

Labs/imaging for spina bifida myelomeningocele

Answer 12

• Fetal ultrasound
• AFP in the blood
• Obvious sac at birth
• Spinal films and CT for defects and hydrocephalus

Question 13

Medical management of spina bifida myelomeningocele

Answer 13

• Immediate surgical intervention to close the defect and correct orthopedic deformities
• Pharma to manage bowel and bladder

Question 14

PT management of spina bifida myelomeningocele

Answer 14

• Family education on positioning and handling, ROM, therapeutic play
• Maximize functional capacity
• WC prescription, AD
• Orthotics and splinting