Spina Bifida: What You Need to Know

What Is Spina Bifida?

Spina bifida is a congenital disorder characterised by the incomplete development of the spine. It is a type of neural tube defect in which the part of the neural tube does not develop or close properly, resulting in defects in the vertebrae (bones of the spine) and spinal cord. The child may be born with a part of the spinal cord exposed on the back through an opening in the spine.

What Are the Types of Spina Bifida?

1. Spina bifida occulta

   • Spina bifida occulta, often called hidden spina bifida, is the mildest and most common type of spina bifida.
   • Most of the time, the gap in the spine is small, and there may be no disturbance to the spinal function.
   • Many individuals may remain unaware of the presence of spina bifida occulta unless it is incidentally detected during an X-ray conducted for an unrelated purpose.

2. Meningocele

   • A severe type of spina bifida.
   • The membrane that covers the spinal cord, known as the meninges, protrudes through the opening of the spine.
   • It results in a sac of spinal fluid in the back.
   • In most instances, the spinal cord and nerves are typically unaffected or only mildly impacted. The sac is usually enclosed by skin and may necessitate surgical intervention.

3. Myelomeningocele

   • The most severe form of spina bifida.
   • The spinal cord does not form properly, and a portion of the spinal cord and nerves protrude through an opening in the spine in a sac. In some cases, the sacs are covered by skin. However, in other cases, nerves and tissues may be exposed.
   • The opening can be surgically closed either while the baby is in utero or shortly after birth.

What Causes Spina Bifida?

While the exact causes of spina bifida are not fully known, several factors can increase the risk of a baby developing this condition.

• Insufficient intake of folic acid (vitamin B9) before conception and during pregnancy. Women should take 400 mcg of folic acid daily while pregnant.
• Family history of spina bifida.
• Medications such as valproic acid and carbamazepine during pregnancy.

How Is Spina Bifida Diagnosed?

Antenatal diagnosis

The tests which will be performed include:

• Blood test: During the 16 to 18 weeks of pregnancy (second trimester), a maternal serum alpha-fetoprotein (MSAFP) screen is done by obtaining a sample of the mother's blood. This test measures the levels of alpha-fetoprotein (AFP), a protein produced naturally by the foetus and placenta.
• Ultrasound: An imaging technique that uses high-frequency sound waves to create a visual representation of the developing baby inside the womb. This method is highly precise in identifying certain birth defects, including spina bifida, during pregnancy.
• Amniocentesis: a sample of the amniotic fluid surrounding the foetus is extracted and analysed for protein levels that could indicate the presence of a neural tube defect or genetic disorder.

Individuals who opt to proceed with the pregnancy should expect more frequent antenatal appointments compared to others who are pregnant.

After birth

Closed neural tube defects are frequently identified at birth through the observation of abnormal fatty masses, tufts or clumps of hair, or small dimples or birthmarks on the skin at the location of the spinal malformation.

Spina bifida occulta is usually discovered incidentally when X-rays are conducted for other reasons.

How Is Spina Bifida Treated?

Treatment depends on the type of spina bifida.

Prenatal surgery (foetal surgery)

• Performed in the second trimester of pregnancy.
• Involves fixing the opening in the spine before the baby is born.
• Foetal surgery may lead to reduced nerve and muscle issues after birth, but it carries potential risks for both the mother and the baby. Additionally, there is a possibility that further surgery may be required for the baby after birth.

After birth

• Surgery soon after birth to close the spinal opening and address hydrocephalus. The primary goal of early surgery is to reduce the risk of infection and further damage to the exposed spinal cord and nerve.
• Services aimed at enhancing daily functioning and promoting independence, such as physiotherapy and occupational therapy.
• Assistive devices like wheelchairs or walking aids.
• Treatments addressing issues related to bowel and urinary functions.

How to Prevent Spina Bifida?

Expectant mothers need to prioritise a balanced and nutritious diet, including sufficient folic acid supplementation, to prevent spina bifida in their unborn child.

Additionally, early prenatal care and consultations with your doctor play a crucial role in addressing and managing factors that could contribute to spina bifida during pregnancy.

Make an Appointment at Pantai Hospitals

Early detection of spina bifida makes it easier to treat the condition with effective and appropriate treatment. A dedicated and expert team of Paediatric specialists at Pantai Hospital is available for consultation to provide the best care and assistance to patients through screening, diagnosis, and treatment.

Get in touch with us to book an appointment today if you have any concerns or questions about spina bifida.

Pantai Hospital has been accredited by the Malaysian Society for Quality in Health (MSQH) for its commitment to patient safety and service quality.