Spina Bifida: A-to-Z Guide from Diagnosis to Treatment to Prevention

Introduction to spina bifida:

Before many women even realize that they are pregnant, their unborn baby’s neural tube has formed and closed at both ends. This tube will become the baby’s spinal cord. When this process goes wrong, it can lead to spina bifida.

Baby, holding the fingers of a loving adult. Spina bifida is present at birth.

What is spina bifida?

Neural tube defects occur when the neural tube does not form or close properly during the first days of development.

A myelomeningocele is a sac that protrudes from the spine. This sac contains spinal fluid, damaged nerve tissue, and meninges (the covering membranes of the spine).

An encephalocele is a similar sac protruding from the back at the top of the neural tube. This sac contains spinal fluid, meninges, and damaged brain tissue.
Anencephaly is the most severe of the neural tube defects. Most of the brain, including the cerebral hemispheres, fails to develop.

Spina bifida refers to the failure of the spinal bones to close properly in the area of the sac. This also happens early in development. It is possible to have it without a protruding sac (spina bifida occulta), but it is not possible to have a myelomeningocele without spina bifida.

Who gets it?

Spina bifida is one of the most common birth defects. It does tend to run in families, but environmental circumstances also come into play. Radiation, chemicals, and drugs (especially anti-seizure medicines) can all increase the risk of neural tube defects.

Inadequate intake of folic acid clearly increases the risk for neural tube defects.

What are the symptoms?

A newborn with spina bifida and a myelomeningocele will often look healthy and normal, except for the sac protruding from the back, usually at the base of the spine.

Most babies with spina bifida and myelomeningocele will develop other complications, including bowel and bladder problems, lower body muscle weakness or paralysis, decreased sensation, and hydrocephalus. Clubfeet, scoliosis, and congenital hip dislocations are more common in those with spina bifida. Developmental or learning problems are also common.

Infections, including urinary tract infections and meningitis, are more common in affected children.

Is it contagious?

No

How long does it last?

While the sac can be closed and repaired, the damage to the nerves is permanent. This leads to ongoing health problems.

How is spina bifida diagnosed?

Several forms of prenatal testing are available to look for neural tube defects.

After birth, the initial diagnosis may be made based on the physical exam. Additional imaging studies, such as CT scans, are often performed to further characterize the problem.

How is spina bifida treated?

Management of spina bifida requires a coordinated team effort. The team usually includes neurosurgeons, orthopedic surgeons, urologists, pediatricians, physiatrists (rehab specialists), physical and occupational therapists, psychologists, and social workers.

The initial treatment includes surgical repair of the protruding sac. Many also need a shunt to prevent or treat hydrocephalus.

Ongoing management is important for the many possible associated problems. Special attention should be paid to the genitourinary system and to issues surrounding walking or other ways to get around.

How can spina bifida be prevented?

One of the most important preventive measures is to ensure adequate folic acid intake. The average American diet contains only about half the folic acid needed to prevent neural tube defects. To be most effective, supplementation should begin before the baby is even conceived.
Women who might get pregnant or who are of child-bearing age should be on a folic acid supplement or be certain they are getting adequate folic acid in the diet.

Related concepts:

Anencephaly, Encephalocele, Myelomeningocele, Neural tube defects

Dr. Alan Greene

As a father of four himself, Dr. Greene has devoted himself to freely giving real answers to parents' real questions -- from questions about those all too common childhood conditions to those that address the most recent and rare pediatric illnesses. His answers combine cutting edge science, practical wisdom, warm empathy, and a deep respect for parents, children, and the environment. He is also an electrifying public speaker, and has personally touched many during his talks in North America, Europe, Asia, and the Middle East.

Dr. Greene is a graduate of Princeton University and the University of California at San Francisco. Upon completion of his pediatric residency program at Children's Hospital Medical Center of Northern California he served as Chief Resident. He entered primary care pediatrics in January 1993.

Dr. Greene is the Past President of The Organic Center and on the Board of Directors of Healthy Child Healthy World. He is a founding partner of the Collaborative on Health and the Environment. He also consults for the Environmental Working Group.

In 1995, he launched DrGreene.com, cited by the AMA as “the pioneer physician Web site” on the Internet. His award-winning site has received over 80 million Unique Users from parents, concerned family members, students, and healthcare professionals. In addition to being the founder of DrGreene.com, he is the Medical Director for HealthTap.

In 2010 Dr. Greene founded the WhiteOut Movement to change how babies in the United States are fed. In 2012 he founded TICC TOCC - Transitioning Immediate Cord Clamping To Optimal Cord Clamping. He is also the founder of KidGlyphs, a free iPhone app that provides a tool for young children to express themselves beyond their verbal skills while teaching them important language skills.

Dr. Greene is the Founding President of the Society for Participatory Medicine and has served as both President and Board Chair of Hi-Ethics (Health Internet Ethics. He is on the Board of Directors for Healthy Child Healthy World, The Lunchbox Project, and The Society for Participatory Medicine. He has also served as an advisor to URAC for both their inaugural and their updated health web site accreditation program. He is a founding member of the e-Patient Scholars Working Group, and a founding board member of the Center for Information Therapy.

Dr. Greene is a regular columnist for Parenting Magazine. He is also the Pediatric Expert for The People’s Pharmacy (as heard on NPR) and Healing Quest (seen on PBS stations). He was the original Pediatric Expert for both Yahoo! and iVillage.

Dr. Greene is the author of Feeding Baby Green (Wiley, 2009), Raising Baby Green (Wiley, 2007), From First Kicks to First Steps (McGraw-Hill, 2004), The Parent's Complete Guide to Ear Infections (People's Medical Society, 1997), and a co-author of The A.D.A.M. Illustrated Family Health Guide (A.D.A.M., Inc., 2004). He is the medical expert for three additional books, The Parent's Soup A-to-Z Guide to Your New Baby, (Contemporary Books, 1998) The Parent's Soup A-to-Z Guide to Your Toddler, (Contemporary Books, 1999), and The Mother of All Baby Books, (Hungry Minds, Inc., 2002).

Dr. Greene is a frequent keynote speaker at important events such as Health 2.0 2011 held in San Diego, CA, IFOAM 2008 (International Federation of Organic Agriculture Movements), held in Modena Italy, the first European Internet health conference, held in Maastricht, the first International eHealth Association Conference, held in Jeddah, and the largest e-Healthcare World Conference, held in Las Vegas, and the first Green Power Baby Shower, held in Hollywood. Dr. Greene also appears frequently on TV, radio, websites, and in newspapers and magazines around the world, including such venues as the TODAY Show, Good Morning America, Fox and Friends, The Dr. Oz Show, CNN, ABC, CBS, and NBC network news, NPR, The New York Times, The Wall Street Journal, USA Today, Time Magazine, Parade, Parenting, Child, Baby Talk, Working Mother, Better Home's & Gardens, and the Reader's Digest.

Dr. Greene loves to think about challenging ideas, he enjoys being where nothing manmade can be seen, and he wears green socks.

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