Spina bifida

Spina bifida is a congenital deformation (the child is born with this disease) of the neural tube.

The neural tube is a narrow canal that undergoes a series of transformations during intrauterine life, in the third and fourth weeks of pregnancy, and will form the brain and spinal cord. Spina bifida occurs when the part of the neural tube that will make up the spinal cord does not close completely.

It is a serious malformation since it affects the central nervous system (the spinal cord), the locomotor system and the genitourinary system. Central nervous system involvement produces hydrocephalus in 90% of cases and a more or less significant loss of sensitivity and strength depending on the level of location of the myelomeningocele.

Causes

Currently, there is consensus that this malformation is due to the sum of two factors: genetic predisposition and folic acid deficiency before conception or alteration of its metabolism by drugs or toxins. It is not hereditary. The chance of having a child with any of these defects is 1.8 to 2 per 1,000 births in the general population. If there is a family history of some type of neural tube defect, there is an increased risk of having a baby with this defect.

Types of neural tube defects

• Closed defects
  • Occult or vertebral fusion defect: it is a small defect in the formation of a vertebra and almost never affects the spinal cord or the spinal nerves that leave it. Most of the time it goes unnoticed by the person and can be detected casually by X-ray. About 15% of healthy people suffer from it
  • Closed spina bifida: occurs at the end of the first trimester of pregnancy and is characterized by presenting as lumps in the lower lumbar area, sometimes with a tuft of hair. They cause minimal neurological injury to the legs but, in many cases, bladder involvement (in the form of a neurogenic bladder) which, in addition, may not cause urine leakage and therefore go unnoticed.

   

• Open defects
  • Meningocele: it is a cyst or sac that contains membranes of the protective layer of the spinal cord (meninges), which appear through the opening of the spinal column. There is cerebrospinal fluid in the sac, and normally there is no nerve damage. . People who have it may have minor disabilities.
  • Myelomeningocele - The cyst contains nerve tissue and cerebrospinal fluid. The cord has not fully developed and is damaged, causing paralysis and loss of sense of touch, below the injury. The degree of paralysis depends on the site of Spina Bifida.

This is the most severe form of Spina Bifida compatible with life, one of the most frequent causes of physical disability in childhood, and the most frequent of neurogenic bladder and neurogenic intestine.

When to see a doctor

• If you have any abnormality in any area of ​​the back: villi, red birthmark or hypopigmentation (white), a deep dimple or pit or a fat bulge
• In case of pain in the back or legs
• Leg weakness
• Back, foot and leg deformities
• Bladder or bowel malfunction
• If you want to have children, since women with EB must take a higher dose of folic acid to prevent it.

Can it be prevented?

Scientific studies explain that if women of childbearing age consumed 0.4 mg of folic acid at least 3 months before becoming pregnant and during the first trimester of pregnancy, they could reduce the probability of having a child with a thorn by up to 70% bifida.

Folic acid is a type of vitamin B essential for the body. The body needs more vitamins in periods of rapid growth, such as pregnancy and the development of the fetus.

As many pregnancies are not planned, a diet rich in folic acid is recommended for women of childbearing age: green leafy vegetables, meat or cereals.

Can it be detected before birth?

Prenatal diagnosis of spina bifida is possible through a series of tests performed on the pregnant woman. These tests have their limitations and some cases of spina bifida may not be identified:

• Maternal blood levels of alpha-fetoprotein are very high if the fetus has a neural tube defect
• In prenatal ultrasound, alterations in the spine and brain can be observed
• The

How is it treated?

There is no definitive treatment for spina bifida, but there are procedures that help minimize the consequences of the disease and improve the patient's quality of life.

If the defect is diagnosed in utero, an elective procedure is performed to minimize the risk of additional injuries if it passes through the birth canal.

The first thing to do is the surgical closure of the defect; With this surgical intervention we will not restore the neurological deficit, as it is impossible, but we will prevent secondary infection of the central nervous system. In the case of hydrocephalus, a ventricular bypass valve should be placed on the baby.

In subsequent treatment, deformities should be minimized and the child's abilities to promote self-esteem and independence should be maximized, avoiding overprotection.

In many cases they need a support for their mobility: crutches, supports or wheelchairs.

In the last 40 years, with the multidisciplinary treatment of these children, 90% have survived to adulthood and 80% have normal intelligence.

On the other hand, physical disabilities can profoundly affect a child's emotional and social development. It is important that doctors, teachers, and parents understand the child's physical abilities and limitations. To promote personal growth, youngsters should be encouraged to be independent, participate in activities with other children without disabilities, and take responsibility for their own care.