What is Spina Bifida?

Spina Bifida occurs when a child is born with an opening in their spine. This is called a neural tube defect. The severity depends on the form of spina bifida. Spina Bifida Occulta is when there is a small opening in the spine, however, most of the time, the spinal cord is not damaged. Normally it is covered by muscle and skin. An extra tuft of hair or a small dimple may mark the area.

Other forms of Spina Bifida include Meningocele is when the meninges, membranes that covers the spinal cord and the brain, protrudes through the opening in the spine, but the nerves do not. Myelomeningocele is when a sac containing nerves and the spinal cord protrudes through the opening in the back. In this case, babies exhibit muscle weakness or paralysis as well as decreased sensation due to the damage to the nerves and spinal cord. The higher in the spine that the opening occurs, the more muscles are affected and are paralyzed. Additionally, 90% of children born with myelomengiocele also develop hydrocephalus or excessive fluid in the brain.

The cause of Spina Bifida is still not completely known. It is has been associated with a lack of folic acid during pregnancy. Further, high fever or exposure to high temperatures during the first few months of pregnancy has been linked to Spina Bifida. Factors increasing the risk that a fetus develops Spina Bifida include obesity, diabetes, and a relative with Spina Bifida.

Complications of Spina Bifida are many. Children with Spina Bifida can have difficulties with their bowel and bladder as the muscles to these areas may be damaged. Learning problems are associated with Spina Bifida as well. Latex allergies and allergies to associated foods are often seen in children with Spina Bifida. Scoliosis, tendonitis, and obesity are also complications noted with this disease. Skin breakdowns due to lack of sensation can also occur.  Orthopedic deformities such as club feet, muscle contractures, and hip dislocations are associated with the condition.

Treatment depends on the degree of complications, but common approaches include:

Children with Spina Bifida need early rehabilitation services consisting of physical, occupational, and speech therapy services. They should be evaluated by an educator as well for possible learning deficits.
Bracing (orthotics and/or long leg braces) and equipment such as walkers, crutches, and wheelchairs are important in the treatment of Spina Bifida.
Myelomengiocele will require surgery to close the area. Additionally, in cases with excessive fluid in the brain, a shunt may need to be placed in the infant's brain to drain the fluid a short time after birth.
Follow up treatment by a good team of doctors including pediatric orthopedists, pediatric neurologists, pediatric physiatrists, urologists, and GI doctors is required.

Other helpful references for information on Spina Bifidas include: Spina Bifida Resource Network, Kid's Health, National Institute of Neurological Disorders and Stroke, Physical Therapy for Children (Campbell, Vander Linden, Palisano, W.B. Saunders Company, 2000), and Clinical Pediatric Physical Therapy (Ratliffe, Mosby, 1998).


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