Diseases & Conditions

 

Spina Bifida

Diseases & Conditions

 What is spina bifida?

Spina bifida which literally means split spine is characterized by a defect in the development of the brain and spinal cord leaving an opening in the spine. It occurs in the first month of fetal life, when the neural tube does not close properly.

There are three common types of spina bifida:1

  1. Myelomeningocele: This is the most serious form of spina bifida in which tissue, nerves and a part of the spinal cord are exposed in a form of a sac in the baby’s back.
  2. Meningocele: This is a mild form of the disease in which only tissues of the meninges are exposed in a form of a sac in the baby’s back.
  3. Spina Bifida Occulta: This is the mildest form of spina bifida in which the opening in the spine is very small and covered with skin.

Spina bifida is one of the most common types of neural tube defect, affecting an estimated 1 in 2,500 newborns worldwide.2 A study conducted in Saudi Arabia found a higher incidence of spina bifida in Saudi Arabia (1.09 in 1.000 newborns) compared to Western countries. The authors concluded that the consanguinity of the parents played a major role and was a significant risk factor.3

 

What are the causes and risk factors of spina bifida?

The exact cause of spina bifida is yet unknown. Scientists suspect a combination of genetic and environmental factors to cause this birth defect.

Mothers with the following characteristics have been found to be at higher risk for having a baby with spina bifida:4,5

  • Vitamin B9 and folic acid deficiency
  • Family history of spina bifida
  • Medications and especially antispasmodics
  • Maternal obesity
  • Gestational diabetes
  • Maternal stress

 

 

What are the symptoms of spina bifida?

Spina bifida can cause a variety of symptoms that differ from one person to another depending on the type of neural tube defect.6

Patients with spina bifida oculta or meningocele do not usually present with any noticeable symptoms.

Patients with myelomeningocele, which is the most severe form of spina bifida, have the meninges and spinal cord exposed through the opening in the spine.

These patients may develop a variety of health problems including:

  • Weakness or paralysis that occurs in the legs and arms
  • Gastrointestinal problems such as constipation
  • Bladder or bowel problems such as urine leakage
  • Compression of the spinal cord creating a curve in the spine
  • Blockage of cerebrospinal fluid causing the build-up of fluids in the brain

 

How is spina bifida diagnosed?

Although, spina bifida is generally diagnosed before birth, some mild cases may be detected after birth. Spina bifida oculta might never be detected.7

Prenatal diagnosis:

  • Blood test: It measures the level of a protein called alpha-fetoprotein which is naturally made by the fetus and placenta. Normally, a small amount of this protein is detected during pregnancy. If the blood test reveals abnormal high levels of alpha-fetoprotein, it may indicate that the baby has an open neural tube.
  • If the blood test shows high level of alpha-fetoprotein, the doctor may request an ultrasound in which the image of the fetus can be seen and signs of spina bifida can be detected.
  • This test consists of the removal of fluid samples from the amniotic sac that covers the fetus. A high level of alpha-fetoprotein can be detected indicating that spina bifida is present.

Postnatal diagnosis:

  • Imaging tests of the baby can detect mild cases of spina bifida oculta:
    • X-ray examination
    • Magnetic Resonance Imaging (MRI)
    • Computed tomography (CT)

 

How is spina bifida treated?

The treatment of spina bifida depends on the severity of the disease:8

  • Surgery: Performing a prompt surgery immediately after the baby is born to close the defect can help preventing further infection or damage.
  • Prenatal surgery: Performing a surgery in the mother’s uterus to close the opening over the developing baby’s spinal cord seems to give better results.
  • Treatment of bladder and bowel problems: It may require surgery to enhance the function of the bladder or bowels.
  • Cesarean birth: A C-section could be a good solution to minimize the amount of damage to the baby’s exposed nerves.

 

Can spina bifida be prevented?

Spina bifida is best prevented by:9

  • Taking 400 micrograms of folic acid everyday before and during early pregnancy. Folic acid is an important vitamin for the development of a healthy fetus.
  • Taking vitamins, and dietary and herbal supplements
  • Controlling diabetes
  • Losing weight
  • Treating fever right away during pregnancy

 

References:

  1. Spina bifida (Spina bifida). http://www.nhs.uk/Conditions/Spina-bifida/Pages/Introduction.aspx (Accessed December 6, 2015)
  2. Spina bifida (Genetics Home Reference). http://ghr.nlm.nih.gov/condition/spina-bifida (Accessed December 6, 2015)
  3. Murshid, Waleed R. "Spina bifida in Saudi Arabia: is consanguinity among the parents a risk factor?" Pediatric neurosurgery 32.1 (2000): 10-12.
  4. (Centers for Disease Control and Prevention). http://www.cdc.gov/mmwr/preview/mmwrhtml/00019479.htm. (Accessed December 6, 2015)
  5. Anderson, James L., et al. "Maternal obesity, gestational diabetes, and central nervous system birth defects." Epidemiology 16.1 (2005): 87-92.
  6. Spina Bifida-Topic Overview (WebMD). http://www.webmd.com/parenting/baby/tc/spina-bifida-topic-overview (Accessed December 6, 2015)
  7. Spina Bifida Fact Sheet (Spina Bifida Fact Sheet). http://www.ninds.nih.gov/disorders/spina_bifida/detail_spina_bifida.htm#3258_7 (Accessed December 7, 2015)
  8. Spina bifida (Treatments and drugs). http://www.mayoclinic.org/diseases-conditions/spina-bifida/basics/treatment/con-20035356 (Accessed December 7, 2015)
  9. Facts (Centers for Disease Control and Prevention). http://www.cdc.gov/ncbddd/spinabifida/facts.html (Accessed December 7, 2015)