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Spina bifida

Klaudia Tomala

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Spina bifida

Pantherstock

Spine

Spina bifida belongs to the group of developmental disorders of the central nervous system. They are caused by a delayed closure of the neural tube in the medullary region or an abnormal course of this process.

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Spina bifida can be divided into:

  1. Open (overt) - there has been no development of the spinal cord and the meninges that cover it.
  2. Closed (latent) - only the bony tissue is affected, but there is no damage to the nerve tissue or the meninges.

The clinical picture of spina bifida is not uniform, as the symptoms depend on the degree of the cleft. On this basis, a distinction is made between:

  1. Latent spina bifida - usually its course is asymptomatic. Alternatively, it may manifest as bedwetting. However, in some cases, a root pain and pressure syndrome may develop.
  2. Meningeal herniation - caused by displacement of the meningeal sac (not containing the cord) outside the spinal canal. Usually the only symptom may be a non-permanent urinary disturbance.
  3. Meningealhernia - caused by displacement of the meningeal sac outside the spinal canal; however, unlike meningeal hernia, the sac contains spinal or root elements. For this reason, this defect is much more severe than the one mentioned above. As a result of damage to the spinal segment, nerve transmission to the organs innervated by it is impaired. Most often, spinal damage is located in the lumbosacral region, leading to impaired function of the lower limbs. This manifests itself as muscle paresis or complete paralysis, weakened or absent reflexes, sensory disturbances, as well as anal sphincter and bladder dysfunction.If the spinal injury is located in the section responsible for innervating the muscles concerned, the following are observed: reduced muscle tone, weakened muscle strength, absent reflexes. Associated symptoms are skin changes - it becomes cold, thin and very dry, and muscle atrophy. However, if the area of spinal cord damage is above the area innervating the muscles concerned, there is an increase in muscle tone, an increase in reflexes and a weakening of muscle strength and movement, i.e. spastic paralysis.In a closed defect, there is a marked increase in glial tissue in the area of the damage, while in an open defect, the characteristic symptom is a persistent exudation of cerebrospinal fluid.
  4. Total spina bifida - is the most serious malformation of all the clefts. It is caused by a non-growth of the neural tube and vertebral arches observed over a space of usually several vertebrae. The thin, split spinal cord is exposed to the outside world because the spinal canal in which it is located is not closed. This is due to the fact that above the cleft area the skin, vertebral arches, meninges and spinal cord have not fused.

The diagnosis of clefts is based on laboratory tests to determine the degree and location of the cleft. Among the basic tests are:

  • magnetic resonance imaging (MRI) - differentiation of clefts in terms of the degree of damage.
  • somatosensory potential testing - used to localise the site of damage, mainly in closed clefts.
  • maternal serum alpha-fetoprotein determination - used as a screening test for open clefts
  • Medical US - provides the opportunity to spot fetal malformations. In the case of clefts, detection is possible as early as 16 - 20 weeks of pregnancy.

Treatment

In the case of clefts, the only treatment method is to perform surgery as soon as possible. The next step is rehabilitation to improve the functions that have been impaired by normalising muscle tone, stabilising and preventing the effects of prolonged immobilisation and spasticity.