Spina bifida: types, causes and treatment

The nervous system is one of the first components that begin to develop during our development, when we are still fetuses. Along the first month of pregnancyin fact already the neural tube that will configure our brain begins to close and spinal cord.

These will be surrounded and protected by the skull and spine. However, in some cases, a malformation occurs that prevents the neural tube and spinal column from finishing. close, remaining open to some degree so that the nerve bundles it contains can suffer various damages and injuries. We are talking about spina bifida.

• Related article: "Spinal cord: anatomy, parts and functions"

What is spina bifida?

We understand by spina bifida a type of malformation produced during fetal development in which part of the neural tube does not completely close during the first month of pregnancy, so that the spinal column The vertebral column does not fully protect the nerves that descend through it, and the spinal cord is exposed to serious injury and damage. variable. Sometimes this opening is visible, although in other cases it is hidden by the skin.

Spina bifida may not cause symptoms in some cases, but depending on the type of malformation, its location and the existence of possible damages in it can generate severe dangerous problems for the subject. The closer the opening to the brain, the greater gravity of the symptomatology as a greater number of nerves are damaged.

Some of the typical symptoms of subjects with spina bifida, specifically due to the presence of spinal cord injuries due to this malformation, may be the presence of gastrointestinal disorders, lack of control of the sphincters and urethra, weakness and lack of sensitivity of the lower limbs or the areas below the injury and it is even possible that there is a total paralysis of said zones.

It must be taken into account that in some cases the opening of the neural tube is very close to the skull and that it can generate alterations such as hydrocephalus or meningitis, with risk of mortality for the affected person. Learning problems and even intellectual disability can occur in some cases.

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Types of spina bifida

Spina bifida is a problem that can present itself in different ways, so it is possible to establish different subtypes based on their characteristics.

1. spina bifida occulta

This is the form of presentation with the least repercussion for the subject, and it is the most common form of manifestation of spina bifida.

In this case, one or more vertebrae have not formed correctly and may have openings, although the nerve tissue remains inside. The malformation is hidden by skin. The subject may have holes or bumps on the back. It does not usually cause serious disabilities, but there may be deformities, incontinence, numbness in one of the limbs or weakness.

2. Cystic or open spina bifida

In this type of spina bifida, part of the spinal cord or the meninges they protrude outside the vertebrae, having a high level of danger for the subject who suffers from them as the nervous material protrudes and is not protected. Are usually form a sac filled with cerebrospinal fluid and of the outstanding material that can be observed externally.

within this type we can find two subtypes.

meningocele

In this case we find a malformation in which the meninges proper to the spinal cord protrude, and the lesion may be exposed or protected by the skin. However, what stands out is only the meninges and cerebrospinal fluid, with the nerve bundles still inside the column.

Myelomeningocele

This is the most severe form of spina bifida. In it the medulla is exposed and protrudes through the opening of the column. In other words, the nerve fiber bundles do not have bony protection, but are exposed on the outside of the spinal column. It can cause severe paralysis that prevents bipedal locomotion and loss of sensitivity and strength of the innervated areas.

Possible causes

spina bifida it is a congenital condition, although not hereditary. Although the elements and mechanisms that cause the neural tube not to finish closing are unknown, it is an alteration that It occurs during the fetal development of the individual, and is usually associated with the presence of low levels of folic acid during pregnancy. There is also speculation about the possibility that there is some kind of genetic influence.

There are other elements that can be risk factors, such as the use of certain psychotropic drugs during pregnancy (for example valproic acid), the presence of fevers high during pregnancy or the age at which pregnancy begins (adolescents and very old people may have higher risk).

Treatment

Spina bifida is a disorder that does not have a fully curative treatment, at least when it comes to damaged nerves. However, it is possible to perform various types of surgery that allow the neuronal matter to be repositioned and protected.

In the case of subjects with spina bifida occulta, treatment may not be necessary (in fact, in many cases it is not detected until advanced ages). Although there may be problems with anchoring the marrow that can cause problems during growth. In this case, yes surgery would be necessary.

In cases of open or cystic spina bifida, an intervention is necessary. In the case of myelomeningocele it is necessary close the tube and protect the neural bundles. Currently it is possible to perform the intervention even in the fetal stage, so that the problem is corrected before delivery so that More damage is avoided than already exists, although these are treatments that can pose some danger to both the fetus and the mother.

Other spine or bone problems resulting from spina bifida may require treatments and surgeries beyond those described above. In cases with hydrocephalus, excess cerebrospinal fluid should also be treated.

Prevention in pregnancy

Another way to avoid this problem is through prevention. It is recommended that during pregnancy The future mother incorporates folic acid into her diet, or take supplements of it.

Special caution is necessary with those adolescent or very old mothers, and in the case of an epileptic person who takes acid valproic acid to discuss with your doctor or psychiatrist possible effects of this medicine or the possibility of using other anticonvulsants such as alternative.