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Spina bifida

Spina bifida

Spina bifida is a congenital condition in which the spinal column around the spinal cord is not completely closed. There is an opening on it which is there at the very beginning of the prenatal development but closes with the completion of the prenatal phase. The condition may vary drastically, which means that the opening can be small and not cause significant difficulties. On the other hand, the opening can also cause a severe disability.

Spine and spina bifida

Spina bifida can be located anywhere on the column of the spine, on one or more vertebrae, but it is most often found at the waist level. It is most commonly located in the lower thoracic, lumbar or coccyx part of the spine and usually affects 3 to 6 vertebrae.

The levels vary between the occult spina bifida, in which there are no obvious disorders, to the shape in which a cystic formation protrudes from the defect (spina bifida cystica) and to the fully open spine (rachischisis) which leads to severe neurological disorders and death.

Such a split of the spine can negatively affect the bladder, causing urine reflux, which can cause hydronephrosis, urinary infections, and kidney damage. The prognosis of the outcome of this condition depends on the degree to which the spinal cord is affected and other causal disorders, but with adequate care.

What causes spina bifida?

The cause is still unknown and research continues, but it is likely that the occurrence is related to genetic and environmental factors. Although there is no evidence of what causes spina bifida, doctors have identified a number of risk factors:

  • Women with diabetes who do not control their blood sugar well have a higher risk of having a child with spina bifida;
  • Pre-pregnancy obesity is associated with an increased risk of congenital nerve tube damage, including spina bifida;
  • Increased body temperature in pregnancy;
  • Anti-seizure drugs;
  • Low socio-economic status, etc.

Taking folic acid supplements during the first trimester may reduce the risk of spina bifida in unborn babies up to 70 %. Since folic acid is a soluble vitamin B that is not kept in the body for too long, it should be taken daily for at least one month before the conception and until the 12th week of pregnancy.

Forms of spina bifida

Cystic spina bifida or myelomeningocele is the most common form in which there is a bladder covered with a thin layer of skin on the lower part of the child’s back. Sometimes there are pigmentation spots or clumps of hair are above the damaged area.  

This cystic formation contains fluid, spinal cord and nerves, resulting in paralysis and loss of sensation below the damaged area, as well as bladder and intestinal problems.

Hydrocephalus occurs in 70-90 % of cases, which is a build-up of cerebral fluid and an imbalance in its leak, so the babies’ heads are of above-average size. The fluid presses the brain and can interfere with their normal development.

 

Meningocele is a milder and rarer form in which the baby has a cluster of cerebral fluid (cerebral-spinal fluid), but damage to the spine is smaller than in myelomeningocele.

Spina bifida occulta is also known as the “quiet” spina bifida because it sometimes affects otherwise healthy people who often do not even know that they have it until they have an RTG for other reasons. There are no visible signs except in some cases moles or holes, and it does not cause significant problems.

The spinal cord and nerves are mostly preserved, while pain and mild neurological disturbances occur in a small number of cases. However, foot deformities, weakened sensations in the legs and hand movements, recurrent urinary infections or stool problems may also occur.

Encephalocele is a form in which the bones of the skull are not completely closed and formed. The bladder or the bag that is formed may contain the cerebrospinal fluid and even a part of the brain. Depending on this, there are also various problems related to the affected brain part. Survival is mainly dependent on surgery, but the consequences are various types of mental disorders.

What should you pay attention to in spina bifida?

Several decades ago, children with more serious forms of spina bifida often did not reach adult age, most often due to infections caused by inadequate care in emptying the bladder and intestines, while today, with appropriate treatments and care, they reach almost the average human age.

Some spina bifida conditions such as hydrocephalus are visible and require more serious treatment and surgery. “Minor” disturbances such as urinary incontinence and constipation are also not to be ignored.

Since the bladder in children and adults with spina bifida is overly active, it is necessary to regulate its emptying to prevent kidney damage and urinary infections, as well as to regulate digestion on a daily basis.

Care for these areas directly affects the length and quality of life.

Some of the treatments available are:

  • neurological-operative — in cases of hydrocephalus;
  • care for urinary and digestion needs;
  • paying special attention to skin care;
  • physiotherapy to strengthen the muscle supporting tissue that supports the spine and alleviates the consequences.

What to take into account when organising everyday life?

  • organisation of day care, kindergarten, school;
  • encouraging autonomy from the earliest days, where possible;
  • integration of the child into society;
  • purchase of needed medical devices such as catheters and wheelchairs;
  • organisation of transport.

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