Spina Bifida

Spina bifida (Latin for “split spine”; SB[9]) is a birth defect in which there is incomplete closing of the spine and the membranes around the spinal cord during early development in pregnancy.[1] There are three main types: spina bifida occultameningocele and myelomeningocele.[1] Meningocele and myelomeningocele may be grouped as spina bifida cystica.[10] The most common location is the lower back, but in rare cases it may be in the middle back or neck.[11] Occulta has no or only mild signs, which may include a hairy patch, dimple, dark spot or swelling on the back at the site of the gap in the spine.[5][1] Meningocele typically causes mild problems, with a sac of fluid present at the gap in the spine.[1] Myelomeningocele, also known as open spina bifida, is the most severe form.[2] Problems associated with this form include poor ability to walk, impaired bladder or bowel controlaccumulation of fluid in the brain (hydrocephalus), a tethered spinal cord and latex allergy.[2] Learning problems are relatively uncommon.[2]

Spina bifida is believed to be due to a combination of genetic and environmental factors.[3] After having one child with the condition, or if one of the parents has the condition, there is a 4% chance that the next child will also be affected.[4] Not having enough folate (vitamin B9) in the diet before and during pregnancy also plays a significant role.[3] Other risk factors include certain antiseizure medicationsobesity and poorly controlled diabetes.[4] Diagnosis may occur either before or after a child is born.[5] Before birth, if a blood test or amniocentesis finds a high level of alpha-fetoprotein (AFP), there is a higher risk of spina bifida.[5] Ultrasound examination may also detect the problem. Medical imaging can confirm the diagnosis after birth.[5] Spina bifida is a type of neural tube defect related to but distinct from other types such as anencephaly and encephalocele.[12]

Most cases of spina bifida can be prevented if the mother gets enough folate before and during pregnancy.[3] Adding folic acid to flour has been found to be effective for most women.[13] Open spina bifida can be surgically closed before or after birth.[6] A shunt may be needed in those with hydrocephalus, and a tethered spinal cord may be surgically repaired.[6] Devices to help with movement such as crutches or wheelchairs may be useful.[6] Urinary catheterization may also be needed.[6]

Rates of other types of spina bifida vary significantly by country, from 0.1 to 5 per 1,000 births.[14] On average, in developed countries, including the United States, it occurs in about 0.4 per 1,000 births.[7][4][15] In India, it affects about 1.9 per 1,000 births.[16] Europeans are at higher risk compared to Africans.[17]

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