SPINA BIFIDA

• The term spina bifida (Latin

for “divided spine”) is most
often used as a collective
term for all spinal cord
disorders, but there are well-
defined degrees of spina
bifida involvement, and not
all neural tube disorders even A meningomyelocele. The infant also has hydrocephalus
and a subluxated hip. (NMSB/Custom Medical
involve the spinal cord. Stock Photograph.)
PATHOPHYSIOLOGY
• Early on in fetal development the ectoderm
which is the outer layer of the fertilized egg
starts to develop a bit of a Ridge that
eventually becomes the neural tube this
neural tube goes on to become the spinal
cord the brain as well as tissues that enclose
and protect them called the meninges.

• Spina bifida occurs when a portion of this

neural tube fails to close properly typically in
the lower back this constitutes

• A defect or absence of the vertebral arch is

due to a failure of mesoderm to organize over
the region of the defect and it may or may not
involve the underlying meninges in neural
tissue
Degrees of spinal cord anomalies.
A. A normal spinal cord.
B. B. Spina bifida occulta.
C. C. A meningocele.
D. A meningomyelocele.
TYPES OF SPINA BIFIDA
Therapeutic Management
• Children with spina bifida occulta need no surgical correction
because there is no tissue extruding from the vertebrae. The
parents should be made aware of the anomaly however, so
they are not surprised if it is revealed on a spinal X-ray taken
for some reason later in life.

• Parents should also receive adequate patient education so

that they can recognize more serious symptoms as the child
grows such as numbness, weakness, or pain, which might
indicate a need for reevaluation. Some children may
eventually need surgery to prevent vertebral deterioration
because of the unbalanced spinal column.
• Treatment for a meningocele or encephalocele involves immediate surgery to
replace the meninges and to close the gap in the skin to prevent infection.
This is done as soon after birth as possible (usually within 24 to 48 hours) so
an infection through the exposed meninges does not occur. The surgery is not
without risk, and if a brain disorder accompanies an encephalocele, the
child’s cognitive potential may be impaired.

• If a large portion of meninges have to be removed by surgery, this can limit the
rate of absorption of CSF, which can lead to a buildup of CSF and
hydrocephalus.

• Children with a meningomyelocele have the same surgery to return the

meninges to the spinal cord and close the gap in the skin surface.

• The child will continue to have partial or complete paralysis of the lower
extremities and loss of bowel and bladder function because, although the
lesion on the back can be repaired, the absent lower cord cannot be
replaced. There also is the same risk of hydrocephalus.
Table 27.1 provides a classification of motor function ability, which can
be anticipated according to the location of a spinal cord disruption.