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Children's Hospital at Dartmouth Hitchcock (CHad)
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About Spina Bifida

Spina bifida means "split" or "open" spine.

Spina bifida is a blanket term used to describe congenital defects of the central nervous system characterized by abnormal or incomplete development of the spine, spinal cord and brain. Many other terms are used to better define the level or type of spina bifida. These include neural tube defect, spina bifida occulta, myelomeningocele, meningocele, encephalocele, lipomyelomeningocele, myelodysplasia, spinal dysraphism, and diastematomyelia.

Due to the abnormal formation of the spinal cord, messages from the brain have difficulty passing to various parts of the body. Therefore, there are several areas of the body where function may be altered or abnormal. These include the central nervous system, the urologic system, and the musculoskeletal system. The degree of abnormality of function in these systems is dependent upon the type, level, and severity of the spina bifida lesion.

Hydrocephalus is a term often associated with spina bifida. It is defined as the abnormal collection of fluid, which normally circulates in and around the brain, within the ventricles of the brain. This is caused by the abnormal shape of the brain referred to as an Arnold Chiari Malformation, and the impingement on the normal flow of the cerebral spinal fluid that results from the abnormal spine formation. In 80-90 percent of babies born with hydrocephalus, a shunt must be placed to drain fluid from the ventricles to the abdominal cavity. This is known as a ventriculo-peritoneal shunt. This may be done at birth when the lesion in the baby's back is repaired, or may be done later as needed.

Bowel and Bladder dysfunction, referred to as neurogenic bowel and bladder, may be seen as a result of the inability of the brain to get messages to organs along the damaged spinal cord. Frequently, individuals with spina bifida are unable to feel when their bladder is full, and cannot empty their bladders as needed, or may be incontinent. It is then necessary to manage their bladder function by catheterization. Catheterization is performed 3 or 4 times daily, is done at home or school, is easy for parents to learn, and for children to perform themselves when they are old enough to learn. Urologic testing is carried out once or twice yearly to screen for problems associated with neurogenic bladder including high pressures, and/or reflux. The degree of bladder dysfunction an individual may have is dependent upon the type and severity of their lesion.

A neurogenic bowel is characterized by the inability of the of a person to feel the need or control the movement of their bowels. Constipation and bowel accidents may be a complication of the neurogenic bowel. These issues may be managed in a variety of ways including a high fiber diet, plenty of fluids, and medication.

The musculoskeletal system and subsequent bone and joint function may develop at different levels in a person with spina bifida, again depending on the level, type, and severity of their spinal lesion. Abilities may range from independent walking without the use of any device, to the need for waist-high braces, a walker, or crutches. It is usually assumed that the lower the level of a lesion a child is born with, the greater their walking potential will be. The type of lesion also plays a role in the determination of future ability. It is very difficult to accurately predict the level of function a child might later be capable of, while that child is still in utero.

Individuals with spina bifida are at greater risk to develop an allergy to latex, a natural rubber found in hundreds of products surrounding us every day like rubber gloves, balloons and even the elastics on underwear or socks. Allergic reactions can range anywhere from itchy eyes to a possible anaphylactic reaction. To help with this potential allergy, persons with spina bifida can use alternative products to latex like vinyl, plastic or silicone.

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