Spina bifida is a congenital defect, in wich the backbone and spinal cord are not well developed. It arises in the first months of pregnancy. The defect is usually located low in the back, at the lumbar vertebrae, but it may also occur at the height of the sacrum or just in the thoracic vertebrae.
Cause
The exact cause of spina bifida is not yet known. Spina bifida is a complex disease of the neural tube, which arises during the embryonic development in the first four weeks of pregnancy. In this disease, the neural tube is not closed. Upon the occurrence of spina bifida, heredity, diet and environmental factors may play a role.
Although the exact cause of spina bifida is thus not known yet, it is clear that taking folic acid prior to pregnancy reduces the risk of spina bifida.
Symptoms
There are two types of spina bifida: spina bifida occulta (closed form), in which the spinal cord is open, but the skin above is closed, and spina bifida aperta (open form), in which both the spinal cord and the skin above are open. If the neural tube has remained open at certain places on the surface of the back, and a pink spot can be seen on the back there, this is called a myelomeningocele. It contains spinal cord and nerves.
Due to spina bifida, several problems can arise, for example:
- Paralysis can occur in the feet, legs and hips.
- The sphincters may malfunction, causing incontinence.
- There are defects of the bladder.
- There may be a great pressure of cerebrospinal fluid in the brains. This allows the child to have hydrocephalus. To counter this, a drain should be placed so that the excess fluid drains off.
Diagnosis
During pregnancy, the diagnosis of spina bifida may already be based on blood tests, ultrasound examination and amniocentesis. After pregnancy, the diagnosis can be made on the basis of a wound at the back of the child. In case of a closed spina bifida, the diagnosis can be made on the basis of an X-ray or MRI scan. Further examination is needed to the bladder and urinary tract, because defects to these organs are often associated with a spina bifida.
Treatment
The treatment of spina bifida is usually includes surgery. During this operation, the opening will be closed. Depending on personal circumstances, several problems may arise as a result of spina bifida. Each of these problems has to be treated differently.
Women who want to get pregnant are advised to take folic acid. Folic acid is a vitamin (B9). This will reduce the risk of spina bifida. It is recommended to start taking folic acid at least four weeks prior to conception and to continue until the eighth week of pregnancy. Even if the pregnancy is long overdue, it isn’t harmful to keep taking folic acid. Women who are at increased risk of having a child with spina bifida, are recommended to take a higher dose. Folic acid is not recommended for women taking valproic acid (an antiepileptic drug), because it may interfere with the working of this drug.
Prognosis
A person with a closed spina bifida will be able to lead a normal life, because this type usually has no consequences. A patient with the open form of spina bifida with myelomeningocele, is at risk of clubfeet and problems with the bladder. Here, everyday life will have to be adjusted.
People with the open form can also be paralyzed, thus physically handicapped. He or she may also be mentally disabled, incontinent and numb. These people are usually in a wheelchair and therefore need many adjustments in daily life.
