Spina Bifida

Spina bifida, is a condition that the spinal bones does not close in the womb as a result of congenital causes. Spina bifida means separated or open spine.  It is one of the most common congenital diseases. Spina bifida can be seen in various types and myelomeningocele is the most common.

Spinal cord is a closed tube, which consists of nerves. These nerves transfer the commands of your brain to the muscles to move them. Also, these nerves help us to feel. If the baby has spina bifida, the tube, known as spinal cord, is open. Therefore, that means the spinal bone and the skin that covers the spinal cord is not closed too. The baby has an opening at his/her back and he/she has difficulties transferring the commands that come from the brain.  Without a normal link between the nerves and the brain, this can cause paralysis at different levels (immobility and feeling loss or inadequate feeling).

Depending on the location of the opening on the back, different nerves may be effected. As the height of the opening goes up, the number of the affected nerves and severity of the paralysis increases. Therefore, some of the spina bifida patients needs none or a little help from devices and some of them needs to use wheelchairs. The muscles that are affected by this disease are not only limited with muscles that are related with movements, the muscles related with urination and defecation can also be affected.

There are three forms of spina bifida in accordance with the opening of the spine

This is the least slightest form of spina bifida. It can show no symptoms. It causes one or more small defects on one or more of the bones that create the spine.  The spinal cord and nerves are normal. Usually, patients are not aware that they have this disease. Usually, the diagnosis of this form is made by chance, when x-ray of the spine is examined for another problem.

Also, different forms of this from, known as spina bifida occulta, that includes more severe and complex anomalies may be existent. The symptoms of this form may be excessive hair growth on the area that is defected (especially on the back; this is known as Hypertrichosis),  colour change on the middle line of the spine (at any point), a small hole (Dermal tractus). It is very important for the babies or children that have problems on their middle line to be examined by a neuro surgeon and if necessary, diagnosing them at an early stage and applying the due treatment to prevent permanent disabilities.

This is the rarest spina bifida form. The membranes that cover the spinal cord herniate to outside from the open side of the spine and create a bag. There is the brain-spinal cord fluid and membrane that cover and protect the brain and the spinal cord in the herniation sack; however, there are no spinal cord or nerve fibres.   The size of this cystic looking structure can differ and it can be located at any level of the spine. In order to provide normal development, the spinal cord membrane will be repaired and the sack will be removed with an operation. Usually, patient do not have a permanent disability and its prognosis is good.

This is the most severe form of the disease. In the hearniated sack, there may be the nerve roots and spinal cord itself, along with the membrance that are present at meningocele. At times, there can be no sack, however, the spinal cord itself may stick to this defect area and the nerve fibres that provide the leg and foot movements and urination and defecation controls may not reach. In this case, despite the surgical operation, there can be permanent disabilities. Despite the surgical treatment, different level paralysis at legs and involuntary urination and defecation may occur. The fluid that covers the spinal cord may flow outside. Until the opening is closed surgically, the babies are under great infection risk. The infection can occur only in the scar area or sometimes it can be meningitis and / or ventriculitis. This condition may cause some negatives related with treatment and prognosis.

Infants with spina bifida may have congenital hydrocephalia or it can develop after the surgical operation.  Hydrocephalia can be defined as the condition that the brain-spinal cord fluid cannot complete its normal circulation and as a result fluid accumulates in the brain spaces known as ventricles.  In this period withou treatment, this condition causes the baby’s head to grow faster than normal, prevents the fontanel from developing, eyes to cross and limits the looks and this condition must be treated.