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Spina Bifida

Spina Bifida Spina Bifida

​​​By: Eliza Gordon-Lipkin, MD, FAAP & Paul Lipkin, MD, FAAP

Spina bifida, which affects the spine and spinal cord, is one of the most common birth defects in babies. In fact, it is the most common birth defect of the nervous system. About 1,600 babies are born with the condition in the United States each year.​​​

What is spina bifida?

Spina bifida, which means “split spine," is a congenital abnormality that occurs before birth. It happens when the neural tube--which later becomes the brain and spinal cord—does not close all the way. This can prevent bones along the spine from forming properly, too.

In babies with spina bifida, part of the spinal column often bulges out on the back. The spinal cord and nerves also may be damaged. This can cause problems with movement, sensation, and other body functions.

Are there are different types of spina bifida?

Yes, there are three major types of spina bifida:

  • Myelomeningocele: This is the most common and severe type of spina bifida. Babies with this type have part of the spinal cord sticking out of the back.

  • Meningocele: In this type of spina bifida, a fluid-filled sack containing the structures that surround the spinal cord sticks out of the baby's back. The sack is sometimes covered by skin. In most cases, the spinal cord and nerves are normal or only mildly affected.

  • Occulta: This is sometimes called “hidden spina bifida." There is no opening in the back. The spinal cord and nerves are usually normal and there is only a small abnormality in the bones of the spine. Some people may never have problems from spina bifida occulta and may not r​ealize they have it. Some people will have a small patch of hair on the lower back. However, in some people, the condition can cause back pain, leg weakness, or bowel and bladder problems. 

What causes spina bifida?​​​

As with other types of neural tube defects (NTDs), doctors don't yet understand all of the causes of spina bifida. Both genetics and the environment likely play a role. Here's what else we know:

  • Parents of a child with spina bifida are at an increased risk of having a second child with a NTDs.

  • Certain medical conditions in pregnant women, like diabetes, are associated with increased risk of having babies born with them. Some medications also increase the risk of NTDs when taken during pregnancy.

  • Folic acid, a B vitamin, can help prevent NTDs when taken before and during pregnancy.

Spina bifida occurs during the first few weeks of pregnancy, often before a woman knows she is pregnant. That's why the American Academy of Pediatrics (AAP) supports the public health recommendation that all women who are able to become pregnant take 400 micrograms (mcg) per day of folic acid.

How do I know if my child has spina bifida?

Spina bifida may be diagnosed during pregnancy or after birth:

  • During pregnancy, several screening tests​ are done at regular prenatal visits that may identify a baby with spina bifida. These include a blood test, ultrasound, and amniocentesis, a screening used to test the fluid that surrounds and protects a baby during pregnancy.

  • After birth, a newborn may be diagnosed with spina bifida when a doctor observes an abnormality somewhere along the spine. An ultrasound, x-ray, MRI (magnetic resonance imaging) or CT (computed tomography) scan may be used to get a clearer picture of the suspicious area.

Are there treatments available for spina bifida?

Yes, treatments are available for spina bifida both before and after the baby is born.

  • During pregnancy, prior to the birth of the baby: If spina bifida is identified during pregnancy, surgery on the baby may be performed in some patients. Many factors need to be considered when deciding whether or not a pregnant mother and baby should undergo this procedure. If eligible, the surgery should be done at a specialized hospital center experienced in fetal surgery.

  • After birth: For babies born with myelomingocele, surgery to close the back is usually recommended within the first two days of life. This surgery is necessary to prevent dangerous infections. However, the surgery does not reverse damage that may have already occurred to nerves of the spinal cord.

In addition to the care provided by a pediatrician, treatments for spina bifida requires a team of specialists. Team members may include neurosurgeons, orthopedic surgeons, urologists, rehabilitation experts, pediatric neurologists, developmental pediatricians, physical therapists, psychologists, and social workers.

What other challenges can people with spina bifida have?

  • Paralysis (the loss of the ability to move). Because nerves leading to the lower part of the body can be damaged in children with spina bifida, the muscles in the legs may be very weak or paralyzed. Joints can also be very stiff. Many babies with this disorder are born with problems in the hips, knees, and feet.

Surgery can help correct some of these problems. In addition, muscle weakness can be treated with physical therapy and special equipment such as braces and walkers. Many children with spina bifida eventually can stand and some can walk. The learning process is often long and challenging.

  • Hydrocephalus (“water on the brain"). Many children with spina bifida eventually develop this condition, caused by excess fluid around the brain. It occurs because the path where fluid usually flows is blocked in spina bifida. The higher up the abnormality is on the spine, the greater the risk is for hydrocephalus. This condition is serious and can be fatal.

Pediatricians may suspect hydrocephalus if the baby's head is growing faster than expected. The condition is confirmed by a CT scan or MRI. It is often treated with surgery to drain excess fluid.

  • Urinary tract infections & bowel problems. Damage to the nerves that control the bladder are more likely to develop urinary tra​ct infections, which can damage the kidneys. Bowel control may also be a problem. Many procedures can be used to treat these problems in people with spina bifida.

Parents of children who have spina bifida and hydrocephalus or urinary tract problems need to watch carefully for signs of infection. Fortunately, the types of infections that can develop with these conditions usually can be treated effectively with antibiotics.

  • Latex allergy. People with spina bifida have an increased risk of developing an allergy to latex. It is not know why; it could develop from frequent exposure to rubber products during exams, tests and procedures. To help reduce a child's overall exposure to latex, parents can try to limit their baby's contact with other products that contain latex (pacifiers, teething toys, changing pads, mattress covers, bandages, and some diapers).

  • Learning & social challenges. Many children with spina bifida do well in school, although they maybe more likely to have devel​opmental and learning disabilities that can benefit from special education. Many also need psychological counseling and emotional support to cope with their health, learning, and social challenges.

  • Other concerns. Children with spina bifida may have problems with their eyes or vision. In addition, about 10% to 15% of children with spina bifida also have seizure disorders.

Remember

Good medical care can greatly improve the quality of life for children with spina bifida and help them reach their full potential.

More Information

About Dr. Gordon-Lipkin

Dr. Eliza Gordon-Lipkin, MD, FAAP, a candidate member of the American Academy of Pediatrics (AAP) Section on Neurology, is a child neurologist at the National Human Genome Research Institute within the National Institute of Health in Bethesda, Maryland. She has special expertise in neurodevelopmental disabilities and sees patients with a broad spectrum of genetic and developmental disorders.

About Dr. Lipkin

Paul Lipkin, MD, FAAP, is an Associate Professor of Pediatrics at the Kennedy Krieger Institute and the Johns Hopkins School of Medicine, specializing in Neurodevelopmental Disabilities and Developmental and Behavioral Pediatrics. He has led important national initiatives for the AAP regarding developmental and autism screening and the care of children with neurodevelopmental disabilities. He has been honored as the recipient of the AAP's Arnold J. Capute Award in 2011 for his efforts on behalf of children with disabilities. Follow him on Twitter at @PaulLipkinMD​.​

Last Updated
6/25/2020
Source
American Academy of Pediatrics Section on Neurology (Copyright © 2020)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
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