Spina Bifida
Spina bifida refers to lesions varying from a flat anomaly of the skin to a severe disruption of all elements in the spinal canal and spinal cord.
It represents a failure of closure of the bony spine at any level.
The different defects are:
1. Spina bifida occulta
* this is the simplest of the defects
* usually asymptomatic
* one can see a discoloration of the skin, hair, lump or a dermal sinus overlying the abnormality which can be confirmed by X-rays
2. Myelodysplasia
* in this defect there are neurologic signs and symptoms present like :weakness, gait difficulties, foot deformities, sensory symptoms, urinary retention, repeated urinary tract infections, enuresis or failure to develop control of bladder function. Also, on PE, foot deformities, weakness of the legs and feet, diminished tendon jerks, unequal foot or leg lengths can be seen.
* it is advised that a myelogram and surgical exploration should be performed
3. Meningocele
* what is seen in this defect is a fluctuant swollen mass covered with full thickness of skin or a thin walled membranous lesion which will transilluminate
* this defect does not contain any neural tissue elements and does not have neurologic symptoms and signs in more than half of cases
* for those who has signs and symptoms, they show gait abnormalities, foot deformities and abnormal bladder function
4. Myelomeningocele
* this defect is the most severe of the spinal deformities
* there is a defect in the spinal cord, spinal nerves, meninges and vertebral bodies
* also known as spina bifida cystica
* may occur in 2-3 cases/ 1000 live births
* mortality is high
* neurologic complications in these defect are: meningitis, hydrocephalus and severe neurologic deficits
* other manifestations in this defect are paraplegia, sphincter disturbances, dislocated hips, profound sensory loss and trophic ulcers