Spina Bifida

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 What is Spina Bifida?

Spina bifida is a birth defect that occurs when the spine and spinal cord do not grow normally during pregnancy affecting 3 out of 10,000 children born worldwide. The problem is classed as a type of neural tube defect. The neural tube is the structure that eventually produces the baby's brain, spinal cord, and the tissues that surround and protect these structures during embryonic development.

The creation of the neural tube begins on the 28th day after conception in a normal pregnancy. Spina bifida occurs when a part of the neural tube does not close or develop properly, causing problems with the spinal cord and the bones of the spine in infants and children.

Other types of Spina Bifida

Other types of spina bifida include:

  • Spina Bifida Occulta: The mildest kind of spina bifida is spina bifida occulta. Spina bifida occulta is often known as "hidden" spina bifida. There is a small gap in the spine with it, but there is no opening or sac on the back. The spinal cord and nerves are normally fine. Spina bifida occulta is frequently not diagnosed until late childhood or maturity. Spina bifida of this form normally does not result in any disabilities.

  • Myelomeningocele: It is the most common and serious form of spina bifida, in which a portion of the spinal cord and accompanying nerves push through the open bones (vertebrae) in the spine and protrude from the foetus' back. The exposed spinal cord and nerves are usually encapsulated in a sac exposed to amniotic fluid. The continuous immersion of the developing spinal cord in amniotic fluid throughout pregnancy is thought to cause gradual neurologic damage. Spina bifida treatment had already been confined to post-birth surgery after damage from chronic amniotic fluid exposure had already occurred.

  • Meningocele: It is another kind of spina bifida. A bag of fluid comes through an opening in the back of the newborn with meningocele. This sac, however, does not contain the spinal cord. Nerve injury is frequently minimal or absent. Spina bifida of this form can cause mild difficulties.


Causes of Spina Bifida

The actual cause of Spina Bifida, like the majority of birth abnormalities, remains unknown to medical professionals. However, there are some risk factors that make Spina Bifida more likely. The following are some of the most common risk factors for Spina Bifida:

  • Folate deficiency: Folate, a natural form of Vitamin B9, is necessary for an embryo's healthy growth. Folate deficiency thereby raises the chance of neural tube abnormalities, such as Spina Bifida.

  • Genetic: Despite the fact that the majority of infants with Spina Bifida are born to parents who have no family history of the disorder, doctors consider genetics to be one of the risk factors. Women who have Spina Bifida or other neurological abnormalities are more likely to have a kid with the condition. Furthermore, having a child with Spina Bifida doubles the chances of having another child with the same problem.

  • Some prescription drugs: A few medications are considered risk factors for Spina Bifida when taken during pregnancy. Medicines for seizures, such as valproic acid, are dangerous because they impair the body's capacity to utilise folate or folic acid.

  • Uncontrolled diabetes: Women who have uncontrolled blood sugar are more likely to have a child with Spina Bifida.

  • Obesity before pregnancy: While weight growth during pregnancy is normal, obesity before pregnancy may raise the chance of birth abnormalities such as Spina Bifida.

  • Hyperthermia: During early pregnancy, an elevated body temperature raises the chance of Spina Bifida. This rise in temperature could be caused by natural factors such as fever, or by activities such as taking a hot bath or sauna.

Symptoms of Spina Bifida

The signs and symptoms of spina bifida vary depending on the type and severity of the condition.

There are usually no signs or symptoms with spina bifida occulta, although you might see a tuft of hair, small dimple or birthmark on a baby’s skin above the affected area.

Signs and symptoms of meningocele and myelomeningocele – such as membranes sticking out, a bulging fluid-filled sac or exposed tissues and nerves – are visible at birth, if they are not detected earlier.

Spina bifida can cause problems such as:
  • Muscle twitching in the foot, hips, or legs
  • Bladder or bowel abnormalities 
  • hydrocephalus 
  • Loss of feeling in sections of the skin (fluid on the brain)
  • Problems with learning
  • Abnormalities with the spine, such as scoliosis
  • Sexual issues
  • Chiari malformation (where part of the brain pushes down into the spinal canal)
Spina bifida only affects the part of the body that receives its nerve supply from the open area of the spine or below that area. It does not affect the brain, heart, chest or arms.

Diagnosis of Spina Bifida

During the second trimester, an expectant mother usually receives a screening that includes a blood test called an alpha-fetoprotein (AFP) test. If the test indicates high levels of alpha-fetoprotein, the mother's unborn child may have a neural tube abnormality such as spina bifida, and an ultrasound will be performed to confirm the diagnosis. The majority of cases of spina bifida are discovered during a normal anatomy ultrasound at 20 weeks (5 months) of pregnancy.

A foetus with spina bifida will appear to have a "lemon-shaped" head during the ultrasound. As the pregnancy proceeds, the indentations on the head will fade. Furthermore, the cerebellum (the back of the brain) will be dragged backward in a "banana sign," indicating a Chiari II malformation (a defect of the spine in which some portion of the brain stem and its surrounding tissue descends into the cervical spine). If a myelomeningocele is present, a more careful ultrasound of the lower section of the spine will often identify a bulging sac. The level of the spina bifida can be determined using 3D ultrasound. Ultrasound can also be used to determine whether the growing foetus has clubfoot or valgus deformity, as well as the existence of normal leg movement (an abnormal positioning of the feet and ankles).

Treatment for Spina Bifida

Treatment for spina bifida differs from person to person depending on the severity of the indications and symptoms. In rare cases, especially with spina bifida occulta, treatment may not be necessary.

Myelomeningocele and meningocele spina bifida, on the other hand, necessitate surgical intervention to realign the exposed nerves and sack. In some situations, parts of the body may need to be removed during surgery. The surgeon then closes the opening over the vertebrae. A shunt may be inserted to prevent difficulties later in life. This type of treatment can be performed immediately after the infant is born. A prenatal operation occurs when a surgical procedure is performed while the kid is still in the mother's womb.

Role of Folic Acid 

Spina Bifida has no cure because it is a structural problem. Parents can take precautions to prevent this neural tube birth abnormality in their unborn children. As previously stated, the most common cause of Spina Bifida is a lack of folate. As a result, taking folic acid supplements from one month before conception until the end of the first trimester can drastically lower the chance of Spina Bifida and other neural tube defects.

Because many women do not realise they are pregnant until later in their pregnancy, some doctors recommend that all women of reproductive age take a daily folic acid supplement of 400 to 1000 mcg. It's also a good idea to include foods rich in natural folate in your regular diet, however folate is not as quickly absorbed by the body as folic acid. Folic acid supplementation may be the preferable option for some ladies. For this reason, women with Spina Bifida, diabetes, or seizures should take a greater dose of folic acid supplement.

Life Expectancy with Spina Bifida

With more research and progress in the subject, 75 percent of children born with an advanced form of this condition can survive early adulthood and live for decades. They did, however, require continued supporting care to thrive. In general, medical specialists estimate that roughly 90% of Spina Bifida patients will live into their third decade. However, because of advancements in medical technology, the life expectancy of people born with spina bifida has grown over time.

Patients with Spina Bifida have a shorter life expectancy because they eat less healthful foods, exercise less, and indulge in sedentary activities such as watching television for lengthy periods of time. They are three times more obese than healthy children, according to reports. Patients with Spina Bifida should exercise on a regular basis and eat a healthy, well-balanced diet.

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