Spina Bifida, types, diagnosis, treatment

What is Spina Bifida?

Spina Bifida is a congenital neural tube defect. It occurs due to abnormal closure of neural tube. Spine and spinal cord don’t form properly. Neural tube is a structure in developing embryo. It eventually forms brain, spinal cord and surrounding tissues. Neural tube forms at the 18th day of pregnancy.

Types of Neural Tube Closure:

Problem in neural tube closure might cause spina bifida. Main damage occur at the level of L4 and L5 nerve root of spinal cord and vertebrae remain open.

Upper Spine Closure	Lower Spine or Caudal Closure
24th Day of Pregnancy	26th Day of Pregnancy

What are the 4 types of Spina Bifida?

There are four types of spina bifida which are discussed below:

• Occulta
• Lipomeningocele
• Meningocele
• Myelomeningocele

Spina Bifida Occulta:

Spine does not fully form. Small gaps between spine bones are present. Meninges, fluid, sac everything remain normal just vertebrae closure do not occur. Spinal cord is intact.

Lipomeningocele:

Fat along with meninges come outside. Spinal cord is intact while bowel disturbance and weakness of lower limb occurs. Surgery is performed to remove this mass.

Meningocele:

It is a problem of fluid present within gaps of spine. Meninges and fluid protrude outward. Sudden surgery is required. Otherwise it may rupture and can cause infection. Patient have diminished gross motor skills. Patient have low body tone. Nerve conduction, somatosensory sensation and motor conduction is delayed.

Myelomeningocele:

Spinal cord and nerves develop outside of body. Patient experiences weakness and sensation loss. While surgery if nerve root gets damage. As a result patient have flaccid legs. It is the most severe and common type.

Causes:

• Genetic
• Nutritional factor
• Folate vitamin B9 deficiency
• Diabetes
• Obesity
• Medications
• Vitamin B12 deficiency

Symptoms:

• Weakness
• Paralysis of legs
• Sleepliness
• Swelling and redness in shunt region
• Dimple
• Hairy patch
• Incontinence
• Foot drop
• Irritability

Diagnosis of Spina bifida:

Perform contraction of hip flexors and knee joint. Foot drop might occur due to peroneal nerve damage. Check out level of injury. If connection from spinal cord is disconnected chances of recovery decreases. Hip joint subluxation occur. In chronic cases, muscular atrophy, contractures and club foot is seen. Somatosensory loss occur. Osteoporosis is seen in bed ridden patients. Scoliosis, ulcers and bed sore formation.

Sciatic nerve damage	Peroneal nerve damage	Spinal cord damage
Legs affected	Foot drop	Paralysis

Myelomeningocele

In spina bifida babies might suffer from hydrocephalus. It is accumulation of extra fluid around brain. Creates increased spaces in brain (ventricles) As a result head size increase. Brain moves from normal placement to spinal column. It might cause blindness and even death.

Treatment:

After 6 months of spina bifida surgery hydrocephalus surgery is performed. For increased CSF fluid shunt is inserted.

VP shunt	AP shunt
Extra CSF moves from ventricles to peritoneum	Extra CSF moves from atria to peritoneum

• Transcutaneous electrical nerve stimulation
• Passive ROM
• Active ROM
• Stretching
• Weight bearing
• Standing
• Braces (KFO)