Spina bifida means a developmental disorder of the spine and the spinal cord. There are different forms with accordingly various neurological deficits.
Spina bifida occulta
The processus spinosus of one or several vertebrae are missing. The covering skin is intact.
But discoloration of the skin, abnormal hair growth, skin appendices, fat pads, or a retraction of the skin draw attention on the hidden spinal deformities, which can be a bening tumour such as an epidermoid or a dermoid. Also lipoma (fatty connection between the spinal cord and the subcutaneous fat) or diastematomyelia (split spinal cord) may be the underlying pathology. In some cases only a fatty thickened end of the string of the spinal cord (filum terminale) is the cause of traction on the spinal cord.
Those abnormalities prevent the normal ascension of the cord, which will cause neurological problems in the course of the child’s development. An early presentation of the patient will help to
Spina bifida aperta
The so-called open spine/back, is the most common form of defects of the neural tube and develops between the 21st and 28th day of pregnancy. It is most probably caused by different factors. With the administration of folic acid prior to conception and through improved prenatal diagnosis, the number of newly diagnosed children at the time of birth is falling.
The incomplete closing of the neural tube presents eventually covered with skin (meningocele) or mostly appears like a mass containing cerebrospinal fluid and the undeveloped neural plate (myelomeningocele).
The neurological deficits are dependent on the location and extension of the defect and are irreversible. In most cases, spina bifida aperta occurs along with other defects such as hydrocephalus, Chiari malformation, syringomyelia, and tethered cord syndrome. Besides these neurological deformities, further defects in the orthopaedic field may occur, such as high arches, hip luxations, scoliosis and kyphosis. Furthermore, in the field of general surgery with inguinal hernia and in the urological sector with urinary bladder disorders.
For these children, not only surgery for covering the defect (preferably within the first 48 hours after birth), is necessary but numerous further surgeries, too. A close cooperation with and within a specialised medical center is highly recommended.