SPINA BIFIDA

I. DEFINITION/ CHARACTERISTICS
Spina bifida is one of a group birth defects known as neural tube defects (NTD). It
occurs in the first month of fetal life, when the neural tube does not close properly,
leaving an opening in the spinal cord and backbone.

(A) Normal spine. (B) Spina bifida occulta. (C) Spina bifida with meningocele.

(D) Spina bifida with myelomeningocele.

TYPES OF SPINA BIFIDA

a. Spina Bifida Occulta

- Failure of the posterior arches to fuse
- Not visible, it may be identified by a dimple or the pressure of tuft or hair at the
point of defect
b. Meningocele
- Meningocele encases meninges, spinal fluid but with no neural elements
- Not associated with neurologic deficits
- Sac covering translucent/ membranous
c. Myelomeningocele (or Meningomyelocele)
- Contains meninges, spinal fluid and nerves. Fluid leakage may occur parallel to
dysfunction
- Lesion poorly covered with imperfect tissue
 - In 90- 95% of cases, hydrocephalus is frequently associated anomaly
II. OVERVIEW OF THE DISEASE
Children and young adults with spina bifida may have medical and developmental
problems. Symptoms vary depending on the location of the defect. In severe forms of
spina bifida hydrocephalus may also occur. Mothers with maternal obesity, diabetes
during pregnancy, maternal stress, maternal fever in the first trimester and previous
baby and family history of spina bifida have been found to be at higher risk for
having a baby with spina bifida. Complications of spina bifida range from minor
physical problems to severe physical and mental disabilities. Other problems include
paralysis or muscle weakness of the lower limbs, gastrointestinal disorders, and skin
breakdown.
III. MEDICAL MANAGEMENT
Spina bifida treatment depends on the severity of the condition. Spina bifida
occulta doesn’t require any treatment at all, but other types of spina bifida do like
myelomeningocele. Performing the surgery early can help minimize the risk of
infection associated with the exposed nerves. It may also help protect the spinal cord
from more trauma.
a. SURGICAL MANAGEMENT
 Name of the procedure:
- Laminectomy and closure of the open lesion or removal of the sac
usually can be done 1 to 2 days after birth
 Purpose:
- The procedure was done to a patient to protect the exposed area
and central nervous system, and to prevent these areas from
becoming infected.

If a myelomeningocele is detected early enough during a woman’s pregnancy, the fetus

can be operated on to correct the defect during the 25 th week of pregnancy. During surgery,
doctors detach the spinal cord from the skin, push the spinal cord back into place, and close the
opening.

Babies who have hydrocephalus also need surgery to ease the build-up of fluid around the brain.
It may require an endoscopic third ventriculostomy procedure or a shunt procedure.

 Ventriculostomy
 - A small opening is made in the bottom of the third ventricle to
allow fluid to exit the brain

 Shunt Procedure
- A thin tube is placed within the brain to drain extra fluid down to
the belly, where the body can absorb it

After recovery from surgery, babies born with meningocele or myelomeningocele

may need long term care to help treat any underlying conditions that result from their
spina bifida. Assistive devices may help children with spina bifida move independently.
This includes:
1. Crutches
- To reduce the amount of weight put on the hips and legs making it
easier to walk. It is convenient method of getting a patient from
one place to another. For crutch walking to be possible, good
balance and erect posture are essential

 Nursing interventions:
• Instruct patient/ significant other to wear a sturdy
and well- fitting shoe
• Rationalize the intervention of teaching the client
to support his weight on the hand pieces not the
axilla. The pressure of the crutch can damage the
brachial plexus nerves producing “crutch
analysis”
• Explain and demonstrate to the patient/ SO the
techniques on how to manipulate the crutches
before the patient attempts to do so.
• Prepare the client for maintaining balance by
asking to him to stand. Holding the patient near
the waist or using a transfer belt would be helpful
in promoting balance
 2. Wheelchairs
- Can be controlled manually or with a motorized button to provide
independence and mobility

 Nursing interventions:
• Make sure the patient maintains anatomically
correct and functional body positioning while in the
wheelchair to promote comfort
• Assess whether the patients wheelchair is adequate
to meet his needs to help him maintain mobility and
independence.
• Demonstrate techniques to promote wheelchair
mobility to the patient and family members.

b. DRUGS
 The medications used most frequently in myelomeningocele are for
treatment of neurogenic bladder dysfunction. These medications are used
in conjunction with some form of bladder emptying technique to prevent
upper urinary tract complications and to facilitate social continence.
Among the drugs used is:
 1. Anticholinergic (Hyoscyamine Sulfate)
- Through parasympatholytic action, hyoscyamine relaxes smooth
muscle spasms. It is indicated in the management of lower urinary
tract disorders associated with hyper motility
 Nursing interventions:
• Discontinue treatment if diarrhea occurs; it may be
a sign of incomplete intestinal obstruction
• May cause drowsiness, caution patient about
performing tasks that requires mental alertness
• Evaluate tachycardia prior to initiating therapy to
avoid possible complications
IV. CONCLUSIONS
Many cases of spina bifida can be prevented if women of childbearing age take
0.4 mg of folic acid every day before pregnancy and continue to take it throughout the
first trimester. Some women may have to take more folic acid, especially if they are
taking the medicine valproic acid for epilepsy or depression. With surgical
procedures, about 90% of babies born with spina bifida live to be adults and lead full
lives. Life- long coordinated interdisciplinary care from a team of medical specialists
is necessary to provide optimum care.
V. HEALTH TEACHINGS