Spina bifida: what it is and how to treat

Spina bifida is characterized by a set of congenital malformations that develop in the baby during the first 4 weeks of pregnancy, which are characterized by a failure in the development of the spine and an incomplete formation of the spinal cord and the structures that protect it.

Generally, this injury occurs at the end of the spine, as it is the last portion of the spine to close, creating a protrusion on the baby's back and may be related to a maternal folic acid deficiency in pregnancy, for example.

Spina bifida can be hidden, when it does not cause problems in the child, or cystic, in which the child may have paralysis of the lower limbs or urinary and fecal incontinence, for example.

Spina bifida has no cure, but it can be treated with surgery to reintroduce and close the defect in the spine, which does not always resolve the complications of the disease. Physiotherapy for spina bifida is also an important treatment aid to promote the child's independence.

Possible causes

The causes of spina bifida are not yet fully understood, but are believed to be related to genetic factors or maternal folic acid deficiency, maternal diabetes, maternal zinc deficiency and alcohol intake during the first 3 months of pregnancy.

Types and symptoms of spina bifida

Types of spina bifida include:

1. Hidden spina bifida

The hidden spina bifida is characterized by incomplete closure of the spine, with no involvement of the spinal cord and the structures that protect it. It can go unnoticed and generally does not have neurological problems and is more frequent in the lower part of the spine, between the L5 and S1 vertebrae, with an abnormal presence of hair and a stain in this region. Learn about hidden spina bifida;

2. Cystic spina bifida

The cystic spina bifida is characterized by the incomplete closure of the spine, involving the spinal cord and the structures that protect it, through a protrusion on the baby's back. It can be divided into:

• Meningocele, which is the mildest form of cystic spina bifida, because the protrusion on the baby's back involves only the structures that protect the spinal cord, leaving the spinal cord inside the vertebrae, as is normal. The protrusion is covered by the skin and in this case the baby does not have neurological problems because the conduction of nerve impulses occurs normally; Myelomeningocele, which is the most severe form of cystic spina bifida, because the protrusion on the baby's back contains the structures that protect the spinal cord and part of it. The protrusion is not covered by the skin, it is open and, in this case, the baby has neurological problems because the transmission of nerve impulses does not occur.

Thus, myelomeningocele can cause problems such as paralysis in the legs, changes in sensation below the lesion, problems in locomotion, urinary and fecal incontinence and learning problems.

Often, myelomeningocele is related to hydrocephalus, which is an increase in cerebrospinal fluid in the brain.

How the treatment is done

The treatment for spina bifida depends on the type, and the hidden spina bifida, in most cases, does not need treatment. In the case of cystic spina bifida, treatment consists of surgery that must be performed in the first days of the child's life to re-introduce all the structures inside the spine and close the defect in the spine. However, this surgery is not always able to prevent some neurological problems.

In myelomeningocele, shortly after birth until being operated on, the baby must lie on his stomach so that the lesion that is open is covered with compresses soaked in saline to prevent infection.

When there is spina bifida sacra with hydrocephalus, surgery is also performed to drain excess fluid from the brain to the abdomen, to prevent or reduce the consequences.

In addition to surgery, physical therapy for cystic spina bifida is a very important treatment option. This procedure aims to help the child to be as independent as possible, helping them to walk or use a wheelchair, to prevent the development of contractures and deformities and to control the bladder muscles and intestines.