Spina Bifida

Spina bifida is a birth defect in which the spinal column does not close completely during early pregnancy, which can leave part of the spinal cord and its coverings exposed or improperly protected. Severity ranges widely, from mild forms causing no symptoms to more significant forms causing lifelong disability.

• In more significant forms: a visible sac or opening on the baby's back, often in the lower spine, sometimes with visible spinal cord tissue
• Weakness or paralysis of the legs, depending on the level and severity of the defect
• Bladder and bowel control difficulties
• Hydrocephalus (fluid build-up in the brain) commonly occurs alongside more significant forms of spina bifida
• Milder forms may cause no visible defect and no symptoms, sometimes only identified incidentally

• Results from incomplete closure of the developing spinal column during the first weeks of pregnancy, often before a woman knows she is pregnant.
• Low maternal folic acid intake around the time of conception is a well-established risk factor.
• Other risk factors include certain maternal medicines (such as some anti-seizure medicines) and, in some cases, family history.

• More significant forms are often visible at birth or detected on antenatal ultrasound.
• Milder forms may be identified incidentally on imaging done for another reason, or through specific examination findings such as a birthmark or dimple over the lower spine.
• Assessment for associated hydrocephalus and for the level and extent of any nerve involvement helps guide management.

Management depends on the severity of the defect and is best provided by a multidisciplinary team, given the range of body systems that can be affected.

More significant forms typically require surgical closure of the defect, often performed soon after birth, and ongoing management of any associated hydrocephalus.

Bladder and bowel management programmes, physiotherapy to support mobility, and orthopaedic care for any limb deformities are important parts of long-term care.

Regular monitoring for complications, including skin breakdown due to reduced sensation and urinary tract problems, is an important part of lifelong follow-up.

With comprehensive, coordinated care, many children with spina bifida go on to lead active, fulfilling lives, though the level of physical support needed varies with severity.

• All women of reproductive age who could become pregnant are recommended to take folic acid supplementation, ideally starting before conception and continuing through early pregnancy, since neural tube closure happens very early in pregnancy.
• Attend antenatal care, which can help detect spina bifida on ultrasound before birth, allowing for delivery and care planning.
• Discuss any anti-seizure or other relevant medicines with a health worker before and during pregnancy, as some carry increased risk.
• Seek early referral to a multidisciplinary spina bifida care team once diagnosed, for coordinated long-term management.