Pediatric Spina Bifida
The University of Florida has a dedicated spina bifida clinic and team headed by Dr. Lance Governale. Please contact our office for more information.
What is Spina Bifida?
Spina Bifida means “open spine”. It refers to a birth defect where the spine does not form normally. Spina Bifida is considered a neural tube defect. The defect usually occurs in the first four weeks of pregnancy. Persons with spina bifida can also have limited use of their legs, bowel and bladder difficulties, hydrocephalus and learning difficulties.
Types of Spina Bifida
This is the most common and most severe form of Spina Bifida. The spinal cord and covering protrude through an opening in the spine. The spinal cord is exposed and the skin over the defect is missing. There is usually damage to the spinal cord resulting in some degree of paralysis and loss of sensation below the defect as well as bladder and bowel difficulties. The neurological deficit depends on where the defect is located. In approximately 90% of patients with myelomeningocele, hydrocephalus or extra fluid on the brain well be present. Most of these patients will require a shunt to treat hydrocephalus. Infants born with myelomeningocele will need surgery shorty after birth to repair the defect. Some children will need additional surgery as they grow due to thethered spinal cord.
Other Terms associated with Spina Bifida
Diastematomyelia refers to a complete or partial clefting of the spinal cord
Hydromyelia: refers to an abnormal dilatation of the central canal lined by ependyma.
This type of Spina Bifida is less common and often less severe. There is a sac of fluid, however the spinal cord does not protrude through the spine. Surgery is required to repair the defect usually there are no long-term problems.
Lipomyelomeningocele is an abnormal fat accumulation that extends from the spinal cord into the tissue of the back. The spinal cord may or may not extend out through the spine. The lesion is covered by skin and usually found in the lower spine area. It is not painful. These lesions typically need to be repaired, however surgery can usually be delayed until the infant is several months of age. Most infants born with lipomyelomeningocele will not have hydrocephalus and will not need a shunt. Most patients will have near normal leg function but may have bladder and bowel difficulties. Some children will need additional surgery as they grow due to thethered spinal cord.
Spina Bifida Occulta
Occulta means hidden, and indicates a defect in one or more of the spinal bones. The skin over the defect is usually normal. Most persons with Spina Bifida Occulta do not need and treatment and most are asymptomatic. There is no increased incidence of spinal cord malformations in patients with spina bifida occulta compared to the general population.
Tethered Spinal Cord
Tethered spinal cord is caused by tissue attachments that limit the movement of the spinal cord within the spinal column. It may be the result of a neural tube defect or may develop due to scar tissue after surgery. Most patients with Spinal Bifida will have a tethered spinal cord. Symptoms may include back or leg pain, bladder or bowel difficulties, weakness, or foot and/or spinal deformities. Surgery may be required if the patient is symptomatic.
Dermal Sinus Tract
This refers to a long, thin, epithelium-lined sinus that extends from the skin surface to the spinal canal. Patients are at increased risk of spinal infections. This is usually repaired surgically.
What are common signs and symptoms of Spina Bifida?
The most common sign of Spina Bifida is an abnormality along the spine that is noted at birth. The abnormality may be an open defect, fatty mass, dimple, or hairy patch.
Persons born with myelomeningocele will usually also have a Chiari Malformation Type II and hydrocephalus.
Symptoms of tethered cord may include back or leg pain, bladder or bowel difficulties, weakness, or foot and/or spinal deformities.
What is the treatment for Spina Bifida?
Most infants born with Spina Bifida will need surgery to correct the defect. During the operation to repair open defects, the spinal cord and its nerve roots are put into place and covered with skin. Often additional surgeries may be required to correct spinal, foot or leg deformities. Many will need a ventriculo-peritoneal shunt to treat hydrocephalus.
What to expect if my child needs surgery
- Myelomeningocele repair
- Lipomyelomeningocele repair
- Excision of dermal sinsus tract
- Tethered cord repair
For more information contact our office at (352) 273-9000.