Spina bifida

for medical and allied Health Professionals

1. Subash Srivastav
Asst Professor

2. Definition
Congenital defect in the posterior bony wall of the
spinal canal involving the laminae
Most commonly seen in the lumbosacral region

3. Development of Spinal cord
2 weeks
5 weeks

4. Development of vertebral column
Notochord–solid rod of cells in front of neural tube
Vertebral bodies develop around Notochord
From each vertebral body 2 projections grow around
the neural tube to form Vertebral arch ORNeural arch
Fusion occurs first in the Thoracic region and extends
upwards and downwards
Failure of fusion of these arches –SPINA BIFIDA

5. Incidence
0.1% , excluding spina bifida occulta
Myelocele –commonest type
Most are still born; in survivors death occurs early due
to infection

6. Types
Spina bifida occulta
Meningocele
Meningomyelocele
Syringomyelocele
Myelocele

9. Spina bifida occulta
Common in lumbar/sacral region
Small gap in one of vertebral arches (frequently only
one vertebra is involved)
Gap is filled with fibrous tissue –no protrusion of cord
or membrane
Indicators–patch of hair, lipoma, sinus, depression
When cord lags behind vertebral column growth –
neurological deficiencies (nocturnal eneuresis,
backache)
Many are symptomless

10. Meningocele
Protrusion of meninges containing only CSF –cystic
swelling which is compressible
Overlying skin remains intact
Common in lumbosacral region; also occipital & root
of nose
No neurological manifestations
If associated with hydrocephalus (Arnold Chiari synd)
Complications –infection, rupture
Surgery required as early as possible

11. Myelomeningocele
Spinal cord along with meningesin the sac
Frequently adherent to the posterior aspect of sac
Skin maybe absent at the summit of the swelling –
infection
Transillumination–nerves within sac
Neurological manifestations are ALWAYS present –
B/L talipesEquinoVarus, atropyof lower limbs or
paralysis of lower limbs, urinary obstruction,
hydronephrosis& UTIs
Surgery -ASAP

12. Syringomyelocele
Rarest variety
Central canal of spinal cord is dilated and the spinal
cord lies within the sac together with nerves
Gross neurological deficits and paralytic
manifestations are seen

13. Myelocele
Most serious form
Along with bony defect, there is defect in development
of spinal cord
Defect discharges CSF continuously
Most are still born, survivors die within a few days due
to infection
Meningomyelocele –most common defect among living
children with NTD