Overview

A birth condition, Spina Bifida, happens when the spine and spinal cord and not developed properly. It is categorized under neural tube defect. The neural tube is the network in a developing embryo that ultimately develops into the baby's brain, spinal cord, and the tissues that enclose them.

Typically, the neural tube forms early in pregnancy, and it completes 28 days after conception. In spina bifida, a part of the neural tube doesn't close or develop adequately, causing spinal cord and the spine's bone problems.

Spina bifida can be benign to fierce, depending on the kind of defect, size, location, and complications. Early treatment involves surgery.

Treatment

As the nerve tissue cannot be replaced or repaired, Spina Bifida has no particular cure. Treatment for its effects may comprise surgery, medication, and physiotherapy. Many people with SB will need assistive devices such as braces, crutches, or wheelchairs. Ongoing therapy, medical care, and/or surgical treatments may be necessary to prevent and manage complications throughout their life. Surgery to close the newborn's spinal opening is typically performed within a day after birth to reduce infection risk and preserve existing function in the spinal cord.

Symptoms

Signs of SB vary by kind and severity, also from person to person.

• Spina bifida occulta. Generally, there aren't any signs or symptoms as the spinal nerves aren't affected. But at times, signs on the newborn's skin above the spinal problem are seen. Sometimes, these skin marks can indicate an underlying spinal cord issue.
• Meningocele. This type may cause issues with bladder and bowel function.
• Myelomeningocele. This is a severe kind of SB. Signs and symptoms involve:
  • The spinal canal remains open in the lower or middle back.
  • The membranes and the spinal cord or nerves protrude at delivery, forming a sac.
  • Tissues and nerves are usually uncovered, though skin covers the sac occasionally.

Typically, myelomeningocele is diagnosed early or right after birth when medical care is available. Kids diagnosed with this condition are supposed to be followed by a specialized team of health care providers throughout their lives. Families must be informed beforehand of the different complications to watch for.

Causes

Experts aren't sure of the causes of SB. Some say it results from congenital, nourishing and environmental risk factors, such as a family history of neural tube defects and vitamin B9 insufficiency.

Risk factors

Spina bifida is prevalent among white skin persons and Hispanics. It's more common in females than males. Doctors and researchers have identified some risk factors:

• Folate deficiency. Folate, the natural form of vitamin B-9, is important to developing a healthy baby. The deficiency of this increases the risk of developing spina bifida and other neural tube defects.
• Family history of neural tube defects. Parents who have had a child with a neural tube defect have a slightly greater chance of having another baby with the same disorder. In addition, women born with the defect have a greater chance of giving birth to a child with SB. 
• Some medications. For instance, anti-seizure medications, such as valproic acid, seem to cause neural tube defects during pregnancy. This might happen since they interfere with the body's ability to use folate and folic acid.
• Diabetes. Women with diabetes or whose blood sugar levels are not well-controlled have a higher risk of having a newborn with spina bifida.
• Obesity. Pre-pregnancy obesity leads to an increased risk of neural tube birth defects.
• Increased body temperature. Some studies suggest that increased body temperature a.k.a hyperthermia in the early pregnancy weeks may increase the risk. 

Complications

Spina bifida may induce minimal symptoms or minor bodily problems. But severe SB can lead to more significant physical conditions. Severity is affected by:

• The size and placing of the neural tube defect
• Whether skin covers the affected area
• Which of the spinal nerves emerge from the affected area of the spinal cord

This list of possible complications may seem overwhelming, but not all children with SB get all of these complications. Most of these intricacies can be treated.

• Walking and mobility problems. The nerves controlling the leg muscles don't function properly below the area of the SB defect. This can cause muscle weakness in the legs and sometimes paralysis. The walking ability usually depends on the location of the defect, its size, and the care received prior and after birth.
• Orthopaedic complications. Children with myelomeningocele can have various problems in the legs and spine because of weak muscles in the legs and back. The problems depend on the location of the defect. Common problems include:
  • Curved spine (scoliosis)
  • Abnormal growth
  • Dislocation of the hip
  • Bone and joint deformities
  • Muscle contractures
• Bowel and bladder problems. Nerves that supply the bladder and bowels generally don't function well when children have myelomeningocele. The reason is because the nerves that supply the bowel and bladder emerge from the lowest level of the spinal cord.
• Accumulation of fluid in the brain (hydrocephalus). Babies born with myelomeningocele commonly experience an accumulation of fluid in the brain, a condition known as hydrocephalus.
• Shunt malfunction. Shunts placed in the brain to treat hydrocephalus can stop functioning or become infected. Warning signs may vary, including:
  • Headaches
  • Vomiting
  • Sleepiness
  • Irritability
  • Swelling or redness along the shunt
  • Confusion
  • Changes in the eyes (fixed downward gaze)
  • Trouble feeding
  • Seizures
• Chiari malformation type II. This is a common problem with the brain in children who have the myelomeningocele type of SB. The lowest part of the brain above the spinal cord, the brainstem, is elongated and positioned lower than norma which can cause breathing and swallowing problems. Rarely compression in this area of the brain occurs, and surgery is needed to relieve the pressure.
• Infection in the tissues surrounding the brain (meningitis). Some newborns with myelomeningocele may grow meningitis, an infection in the tissues surrounding the brain. This potentially life-threatening infection may lead to brain injury.
• Tethered spinal cord. Tethered spinal cord results when the spinal nerves bind to the scar that surgically closed the defect. This progressive tethering can cause loss of muscle function in the legs, bowel or bladder. 
• Sleep-disordered breathing. Children and adults with spina bifida may have sleep apnea or other sleep disorders, particularly myelomeningocele. Assessment for a sleep disorder in those with myelomeningocele helps detect sleep-disordered breathing, such as sleep apnea, warranting treatment to improve health and quality of life.
• Skin problems. Children with SB may get wounds on their feet, legs, buttocks or back. They can't feel it when they get a blister or sore which can turn into deep wounds or foot infections that are tough to treat. Such children have a greater risk of wound problems in casts.
• Latex allergy. Children with SB have a greater risk of latex allergy that may cause severe complications. It can also cause anaphylaxis, a potentially life-threatening condition where swelling of the face and airways can make breathing difficult. 
• Other complications. More problems may arise as children with SB get older, such as urinary tract infections, gastrointestinal (GI) disorders and depression. Children with myelomeningocele may develop learning disorders.

Prevention

Folic acid in supplement form consumed at least one month before conception and continuing through the first trimester of pregnancy reduces the risk of SB and other neural tube defects.

Planning pregnancy

Adult women who are planning to conceive or who could conceive should be advised to get 400 to 800 mcg of folic acid a day.

As folic acid isn’t sufficient all alone, so vitamin supplements are necessary to prevent SB. And it's possible that folic acid will also help reduce the risk of other birth defects, like cleft lip, cleft palate and a few congenital heart defects.

It's also recommended to eat a healthy diet, including foods rich in folate or enriched with folic acid. 

When are higher doses needed?

If one has spina bifida or if has previously given birth to a child with spina bifida, the person needs extra folic acid before conceiving. If one is taking anti-seizure medications or has diabetes, they may also benefit from a higher dose of this vitamin B. Check with the doctor before taking additional folic acid supplements.

Fact Check:

• Treatment for Spina Bifida can help, but this condition can't be cured permanently
• There are Fewer than 1 million SB cases per year in India
• Spina bifida can be caused by both genetic or environmental factors.
• Neural tube defects, including spina bifida, are usually diagnosed before birth, through lab or imaging tests, such as ultrasounds.
• Unfortunately, spina bifida is not always detected, or parents are not always informed of its presence. Failure to diagnose spina bifida, failure to inform parents of the condition, or failure to act in a timely fashion if it is detected can all result in a child being born with life-altering symptoms that can significantly impact them in the long-term.

PGC Resolution: To raise awareness about SB in India and actively support and protect parents and children towards improving the affected children's abilities from the condition being undetected, detected but not properly treated, or the mother not being made aware of the risk of taking certain medications while pregnant. Over the years, we have helped cure handful of patients with spina bifida.