Spina-Bifida

Cleft spine / Open spine

Arham Shamsi
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 Spina-Bifida /Cleft spine / Open spine
Comes from Latin > Split Spine
A birth defect. When tissues over spinal cord on left and
right do not meet completely to form a complete seal ,
leaving behind various degree of opening.
 Fetal Development
Early on fetal development the ectoderm which is outer
layer of fertilized egg start to develop a ridge that
eventually becomes Neural tube develops into Spinal
cord ,Brain , Nerve and Meninges.
Spina Bifida occurs when portion of neural tube fails to
close properly specially in lower back.
There is absence of vertebral arches due to failure of
mesoderm to organize over the region of defect. This
process may nor may not involve meninges or neural
tissues.
 TYPES
There are three types.
1. Myelomeningocele
2. Meningocele
(Meningeo Cyst)
3. Occulta
Types
 Myelomeningocele
Most severe type in which Spinal Cord and
meninges protrude out into vertebra ,held
together by a sack of skin that pouches out from
back.
In very severe cases there id no skin at all (open
Spina Bifida) there can be serious damage to
spinal cord , loss of sensation, paralysis, bladder
and bowel issues, seizure and foot deformities.
 Arnold Chiari malformation
Myelomeningocele is associated with (Chiari
malformation II) previously known as Arnold-
Chiari malformation) a condition in which
cerebellum and brain stem slips down in
foramen magnum leads to hydrocephalus which
is abnormal accumulation of CSF. Cerebellar
symptoms are also present.
 Meningocele (Meningeo Cyst)
Prenatal deformity results only in meninges
NOT the Spinal Nerves.
Meninges spilt out in deformed vertebra.
Least common. As spinal cord in not involved no
serious symptom.
 Occulta
Occulta = Hidden
Most Common and Mildest form. Due to its hidden
nature most of the test for diagnosis don’t make a
diagnosis, there are NO symptoms as well. Neither
spinal cord nor surrounding tissues protrudes. As
spinal cord is not damaged ,people with this type
remain asymptomatic. Condition usually found
accidently in life. At most people have a dimple, hair
tuft or a birth mark on back above the site of lesion.
 CAUSES
Cause is Unknown of all three types BUT there are
known Risk Factors
Folate Vit. B9 deficiency during fetal fetal
development. That s prenatal vitamin why include
Folic acid which is manufactured form of Folate.
Developmental deformation that cause Spina
Bifida occur in fourth week of pregnancy (21-28
days) at this time women might not know that she
is pregnant so no preventive measures are taken
 Risk factors
Further Risk Factors may be Obesity, DM,
Medication like anti seizures as they influence
Folate metabolism.
 Preventive Measures
Folic acid is a B vitamin. It helps the body make healthy new
cells. Everyone needs folic acid. For women who may get
pregnant, it is really important. Getting enough folic acid before
and during pregnancy can prevent major birth defects of her
baby's brain or spine.
Foods with folic acid in them include:
Leafy green vegetables ,Fruits, Dried beans, peas, and nuts
Enriched breads, cereals and other grain products
If you don't get enough folic acid from the foods you eat, you can
also take it as a dietary supplement.
NIH: National Institutes of Health Office of Dietary Supplements
 Diagnosis
For Myelomeningocele Increased levels of Alpha
Fetoprotein in mother’s serum (AFP) is done prenatally.
(which can happen when skin surrounding Fetus’s spine
is missing and AFP leaks out into amniotic fluid, into
mothers blood stream
Human Chorionic Gonadotropin (HCG)
Fatal Ultrasound Ultrasound can be performed during
the first trimester (11 to 14 weeks) and second trimester
(18 to 22 weeks). Spina bifida can be accurately
diagnosed during the second trimester ultrasound scan
 Diagnosis
Amniocentesis
If the prenatal ultrasound confirms the diagnosis of spina
bifida, your doctor may request amniocentesis. During
amniocentesis, your doctor uses a needle to remove a
sample of fluid from the amniotic sac that surrounds the
baby.
This examination may be important to rule out genetic
diseases, despite the fact that spina bifida is rarely
associated with genetic diseases.
https://www.mayoclinic.org/
Presentation
MSK
Urinary
 PT Treatment
Practicing functional activities such as sitting, transferring and
walking
Correcting posture in lying sitting and standing
Exercises that are fun and stimulating to maintain or improve
muscle strength
Stretching tight muscles to prevent development of contractures
Provision of appropriate orthotics
Exercises to improve balance and coordination and to prevent risk
of falls
Hydrotherapy to maximise strength and mobility

https://www.physio.co.uk/