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Spina Bifida in India

Spina bifida (Latin: “split spine”) is a birth defect where there is incomplete closing of the backbone and membranes around thespinal cord.  It is a type of neural tube defect. The most common location is the lower back, but in rare cases it may be the middle back or neck. Spina bifida is believed to be due to a combination of genetic and environmental factors.

There are four types of spina bifida:  occulta, closed neural tube defects, meningocele, and myelomeningocele.

Occulta is the mildest and most common form in which one or more vertebrae are malformed.  The name “occulta,” which means “hidden,” indicates that a layer of skin covers the malformation, or opening in the vertebrae.  This form of spina bifida  rarely causes disability or symptoms.

Closed neural tube defects make up the second type of spina bifida.  This form consists of a diverse group of defects in which the spinal cord is marked by malformations of fat, bone, or meninges.  In most instances there are few or no symptoms; in others the malformation causes incomplete paralysis with urinary and bowel dysfunction.

In the third type, meningocele, spinal fluid and meninges protrude through an abnormal vertebral opening; the malformation contains no neural elements and may or may not be covered by a layer of skin.   Some individuals with meningocele may have few or no symptoms while others may experience such symptoms as complete paralysis with bladder and bowel dysfunction.

Myelomeningocele, the fourth form, is the most severe and occurs when the spinal cord/neural elements are exposed through the opening in the spine, resulting in partial or complete paralysis of the parts of the body below the spinal opening.  The impairment may be so severe that the affected individual is unable to walk and may have bladder and bowel dysfunction.

Causes of Spina Bifida

The cause of spina bifida is unknown, although a number of things that can increase the risk of the condition have been identified

  • Excessive use of alcohol
  • High fever in early pregnancy
  • Uncontrolled diabetes in the mother
  • Folic acid deficiency during pregnancy
  • Exposure to high temperatures
  • Family History
  • Obesity

Symptoms of Spina Bifida

The symptoms of spina bifida vary from person to person, depending on the type and level of involvement.   Closed neural tube defects are often recognized early in life due to an abnormal tuft or clump of hair or a small dimple or birthmark on the skin at the site of the spinal malformation.

Meningocele and myelomeningocele generally involve a fluid-filled sac—visible on the back—protruding from the spinal canal.  In meningocele, the sac may be covered by a thin layer of skin. In most cases of myelomeningocele, there is no layer of skin covering the sac and an area of abnormally developed spinal cord tissue is usually exposed

Treatment of Spina Bifida

A care plan may be recommended to address the needs of your child and any problems they have. As your child gets older, the care plan will be reassessed to take into account changes to their needs and situation.

There are several different treatments for the various problems spina bifida can cause. These are described below.

Initial surgery to repair the spine

In babies with spina bifida, nerves and membranes are able to push out of an opening in the spine and form a sac. This damages the nerves and can lead to serious infections, so surgery to repair the spine will usually take place within 48 hours of birth.
During surgery, the surgeon will place the spinal cord and any exposed tissues or nerves back into the correct place. The gap in the spine is then closed and the hole is sealed with muscle and skin

Physiotherapy

Physiotherapy is one of the most important ways of helping someone with spina bifida be as independent as possible.
The main aim of physiotherapy is to promote movement and prevent the leg muscles from weakening

Occupational therapy

  • The aim of occupational therapy is to help find ways to carry out everyday activities
  • Assistive devices and mobility aids
  • Assistive devices can help people with spina bifida gain more independence and overcome their movement difficulties.
  • People who are unable to use their legs will usually require a wheelchair. Leg braces and other walking aids can be used by people who have weakness in their leg muscles

Bladder Surgery: This surgery is performed for tightening the muscles and also for increasing the bladder size.
Continence Pads and Self-Catheterisation: Urinary incontinence is very essential to manage. Urinary or faecal bags are sometimes required.

Health Issues to Children with Spina Bifida

The long-term effects of spina bifida will vary based upon type ofspina bifida, the severity of the child’s symptoms, and the location of the defect in the spinal cord (the higher the defect, the greater thecomplications) and may include: Chiari II malformation. Hydrocephalus and shunt blockage. Bed sores .Living with spina bifida isn’t exactly the same for each kid who has it. But for most kids, it means taking extra care of their bodies and paying attention if something seems wrong. It can mean taking longer to do things, because braces, crutches, and wheelchairs just aren’t as fast as walking and running.

Urine and kidney problems

Almost all patients with Spina Bifida will require lifelong antibiotics to prevent infection.

Bowel problems

Most Spina Bifida children have some problem controlling their bowel movements. Constipation is the most common problem and can often be controlled by medicines

Hydrocephalus

Patients who have spina bifida may also experience accumulation of the fluid within the skull. Arnold Chiari malformation is responsible for causing this condition. Shunt surgery is required immediately in this condition.

Muscles and movement

Careful orthopaedic follow-up of Spina Bifida patients is required. Although the amount of movement and strength that the child has in the legs does not tend to change, increasing weight of the child may cause progressive problems with walking.

Intellect and education

Around 75% of children with Spina Bifida have some learning difficulties. The most common problems are concentration, short-term memory, organisational skills, hand/eye coordination, and motivation

Emotional Effects: A child with spina bifida can experience emotional distress such as low self-esteem, insecurity and depression