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09/19/2020 Sophia Hogg


Spina Bifida

What is Spina Bifida?

Spina bifida is a birth deformity that happens when the spine and spinal cord do not form properly. It is a kind of neural tube deformity. The neural tube is sort of a structure in an evolving embryo that ultimately becomes the baby's brain, spinal cord and the tissues that surround them.

Generally, the neural tube forms early in pregnancy and it closes by the twenty eight day after formation. In babies with spina bifida, a part of the neural tube does not close or develop properly, causing deformities in the spinal cord and in the bones of the spine.

Spina bifida might start from mild to severe, relying upon the type of deformity, size, location and complications. When required, early treatment for spina bifida involves surgery however such treatment does not always completely resolve the problem.


Spina Bifida Types

Spina bifida might happen in different types: spina bifida occulta, myelomeningocele or the very rare type meningocele.

Spina bifida occulta

"Occulta" indicates hidden. It is the mildest and most basic type. Spina bifida occulta results in a little separation or opening in one or more of the bones of the spine or the vertebrae. Many people who have spina bifida occulta are not aware about it, until and unless the condition is detected during an imaging test done for unrelated reasons.

Myelomeningocele

Also called as open spina bifida, myelomeningocele is the most serious type. The spinal canal is open along many vertebrae in the lower or middle back. The membranes and spinal nerves move through the opening at birth, creating a sac on the baby's back, customarily exposing tissues and nerves. This makes the baby vulnerable to life threatening infections and might also cause paralysis and bladder and bowel dysfunction.

open spina bifida

Spina Bifida Symptoms

Symptoms of spina bifida vary by type and seriousness, and also between individuals.

  •   Spina bifida occulta - Typically there are not any signs or symptoms because the spinal nerves are not involved. But you might sometimes see signs on the newborn's skin above the spinal deformity, including an abnormal tuft of hair, or a small dimple or birthmark. At times, the skin marks might be signs of an underlying spinal cord problem that might be discovered with MRI or spinal ultrasound in a newborn.
  •   Myelomeningocele – In this serious type of spina bifida
    • The spinal canal remains open along many vertebrae in the lower or middle back.
    • Both the membranes and the spinal cord or nerves protrude at birth, developing a sac.
    • Tissues and nerves are usually exposed, though sometimes skin covers the sac.

Spina Bifida Causes

Healthcare providers are not certain what causes spina bifida. It is thought to result from a combination of genetic, nutritional and environmental risk factors, for instance a family history of neural tube deformities and folate (vitamin B-9) deficiency.

Diagnosis

If you are pregnant, you will be offered prenatal screening tests to check for spina bifida and other birth deformities. The tests are not perfect. Sometimes mothers who have positive blood tests have babies without spina bifida. Even if the results are negative, there is still a small chance that spina bifida is still there. Talk to your healthcare provider about prenatal testing, its risks and how you can handle the results.

Blood tests

Spina bifida might be screened with maternal blood tests, but normally the diagnosis is done with ultrasound.

  •   Maternal serum alpha-fetoprotein (MSAFP) test - For the MSAFP test, a specimen of the mother's blood is drawn and tested for alpha-fetoprotein (AFP) — a protein produced by the baby. It is normal for a small amount of alpha-fetoprotein to cross the placenta and enter the mother's bloodstream. But abnormally high levels of AFP indicate that the baby has a neural tube deformity, such as spina bifida, though high levels of AFP do not always happen in spina bifida.
  •   Test to confirm high AFP levels - Varying levels of AFP might be caused by other factors — including a miscalculation in fetal age or multiple babies — so your healthcare provider might order a follow-up blood test for confirmation. If the results are still high, you will require further evaluation, including an ultrasound exam.
  •   Other blood tests - Your healthcare provider might perform the MSAFP test with two or three other blood tests. These tests are commonly done with the maternal serum alpha-fetoprotein test, but their objective is to screen for other abnormalities, for instance trisomy 21 (Down syndrome), not neural tube deformities.


Ultrasound

Fetal ultrasound is the most precise method to diagnose spina bifida in your baby before delivery. Ultrasound might be performed during the first trimester (11 to 14 weeks) and second trimester (18 to 22 weeks). Spina bifida might be accurately diagnosed during the second trimester ultrasound scan. Therefore, this examination is important to identify and rule out congenital anomalies such as spina bifida.

An advanced ultrasound also might detect signs of spina bifida, for instance an open spine or specific features in your baby's brain that suggest spina bifida. In expert hands, ultrasound is also effective in assessing seriousness.

Spina Bifida


Spina bifida examination

Amniocentesis

If the prenatal ultrasound verifies the diagnosis of spina bifida, your healthcare provider might request amniocentesis. During amniocentesis, your healthcare provider uses a needle to remove a specimen of fluid from the amniotic sac that surrounds the baby.

This examination might be important to rule out genetic diseases, despite the fact that spina bifida is rarely related with genetic diseases.

Discuss the risks of amniocentesis, including a slight risk of loss of the pregnancy, with your healthcare provider.

Specialty Care Clinics are located in 6 different locations throughout Texas - Lancaster, Plano, Midland, Ennis, Fort Worth and Farmers Branch.


Spina Bifida Treatment

Spina bifida treatment depends upon the seriousness of the condition. Spina bifida occulta usually does not require any treatment at all, but other types of spina bifida do.



Surgery before birth

Nerve function in babies with spina bifida might worsen after birth if spina bifida is not treated. Prenatal surgery for spina bifida or fetal surgery takes place before the twenty sixth week of pregnancy. Surgeons view the pregnant mother's uterus surgically, open the uterus and fix the baby's spinal cord. In select patients, this procedure might also be performed less invasively with a fetoscope through ports in the uterus.

Research indicates that children with spina bifida who had fetal surgery might have reduced disability and be less likely to need crutches or other walking devices. Fetal surgery might also reduce the risk of hydrocephalus. Ask your healthcare provider whether this procedure might be appropriate for you. Discuss the potential benefits and risks, for instance possible premature delivery and other complications, for you and your baby.

It is important to have a comprehensive evaluation to determine whether fetal surgery is possible. This specialized surgery must only be done at a healthcare facility that has skillful fetal surgery experts, a multispecialty team approach and neonatal intensive care. Customarily the team consists of a fetal surgeon, pediatric neurosurgeon, maternal-fetal medicine specialist, fetal cardiologist and neonatologist.



Cesarean birth

Several babies with myelomeningoceles tend to be in a feet-first (breech) position. If your baby is in this situation or position and if your healthcare provider has discovered a large cyst or sac, cesarean birth might be a safer way to deliver your baby.



Surgery after birth

Myelomeningocele needs surgery. Performing the surgery as early as possible might help minimize the risk of infection related with the exposed nerves. It might also help protect the spinal cord from more trauma.

During the procedure, a neurosurgeon places the spinal cord and vulnerable tissue inside the baby's body and covers them with muscle and skin. At the same time, the neurosurgeon might place a shunt in the baby's brain to control hydrocephalus.

Treatment for complications

In babies with myelomeningocele, irreversible nerve damage has likely already happened and ongoing care from a multispecialty team of surgeons, physicians and therapists is often required. Babies with myelomeningocele might need more surgery for a variety of complications. Treatment for complications for instance weak legs, bladder and bowel problems, or hydrocephalus usually begins soon after birth.

Depending upon the seriousness of spina bifida and the complications, treatment options might include:


  •   Walking and mobility aids - Some babies might start exercises to get their legs ready for walking with braces or crutches when they are older. Some children might need walkers or a wheelchair. Mobility aids, along with regular physical therapy, might help a child become independent. Even the children who do require a wheelchair might learn to function very well and become self-sufficient.
  •   Bowel and bladder management - Routine bowel and bladder examinations and management plans help lower the risk of organ damage and illness. Examinations involve X-rays, kidney scans, ultrasounds, blood tests and bladder function studies. These examinations will be more common in the first few years of life but less often as children grow. A specialist in pediatric urology with experience in examining and carrying out surgery on children with spina bifida might offer the most effective management options.
    Bowel management might include oral medications, suppositories, enemas, surgery or a combination of these approaches. Bladder management might include medications, using catheters to empty the bladder, surgery or a combination of treatments.
  •   Surgery for hydrocephalus – Most of the babies with myelomeningocele will require a surgically placed tube which permits fluid in the brain to drain into the abdomen (ventricular shunt). This tube can be placed just after birth, during the surgery to close the sac on the lower back or later as fluid gets collected. A less invasive procedure, known as endoscopic third ventriculostomy, might be an option. But candidates should be carefully chosen and meet certain criteria. During the surgery, the surgeon will use a small video camera to see inside the brain and make a hole in the bottom of or between the ventricles so cerebrospinal fluid might flow out of the brain.
  •   Treatment and management of other complications - Special equipment for instance bath chairs, commode chairs and standing frames might help with daily functioning. Whatever the issue orthopedic complications, tethered spinal cord, GI issues, skin problems or others most spina bifida complications might be treated or at least managed to improve quality of life.

Ongoing care

Children with spina bifida require close follow-up care and observation. Their primary care physicians examine growth, the requirement for vaccinations and general medical issues, and they coordinate medical care.

  •   Physical medicine and rehabilitation
  •   Neurology
  •   Neurosurgery
  •   Urology
  •   Orthopedics
  •   Physical therapy
  •   Occupational therapy
  •   Special education teachers
  •   Social workers
  •   Dietitians

Parents and the other caregivers are a key part of the team. They may learn how to help manage a child's condition and how to encourage and support the child emotionally and socially.

Specialty Care Clinics are located in 6 different locations throughout Texas - Lancaster, Plano, Midland, Ennis, Fort Worth and Farmers Branch.



If you or anyone you know is suffering from spinal diseases and disorders or chronic lower back pain, our expert providers at Specialty Care Clinics take care of your health and help you recover.

Call 469-805-4561 to book an telehealth appointment for an at home check-up.

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