What is spinal bifida? – Swelling or wound at the back of a newborn baby is referred to as spinal bifida. It simply means open or split spine. Parents often get alarmed when they see their newborn baby with an open wound or swelling at the back. It occurs due to incomplete formation of the bones (spine) that cover the spinal cord. The spinal cord may then project outward through the defect in the spine.

Is spinal bifida a life-threatening condition?

Babies born with spinal bifida usually survive but with varying degrees of disabilities, depending on the degree to which the spinal cord is affected. 

What are the degrees of spinal bifida?

The degree of the defect represents how much of the spinal cord tissues and nerves protrude through the defect and the attendant disability.

1. Spinal bifida occulta (hidden defect) –This is the most common type, which the affected person may not even be aware of. The gap in the bone, at the point of defect is minimal and effectively hidden by other layers of tissues above the bone. The spinal cord and nerves are not affected in any way. It is usually discovered when X-ray is done for other medical purposes.
2. Meningocoele – This refers to fluid accumulation inside the covering (meninges) of the spinal cord and protruding through the defect in the spine, which may be covered by skin. This is the least common type. Affected persons may or may not present with any symptoms. Those with symptoms may present with difficulty in controlling urine or faeces.
3. Myelomeningocele – This describes a fluid-filled swelling containing the cord (with or without its nerves) and its coverings (meninges), protruding through the defects in the spine. The point of protrusion may be single or multiple. The part of the cord and nerve contained in the protrusion often get damaged. It is the most severe type of spina bifida.

What are the symptoms of spinal bifida?

The most obvious symptom is swelling at the back for those with meningocoele and myelomeningocoele while those with spinal bifida occulta may not be obvious. These swellings sometimes become wound when they burst open, exposing the delicate meninges and spinal cord. Other symptoms depend on the level at which the defect occurs and its severity. They may include:

1. Poor urine and bowel control
2. Weak leg muscles
3. Abnormally shaped legs
4. Fluid accumulation in the brain (hydrocephalus)
5. Difficulty with breathing and swallowing
6. Weak upper limb muscles

What causes spinal bifida?

The cause of spinal bifida is not clearly known. However, some genetic and environmental factors have been associated with its development. These include:

1. Low / deficiency of folate – The development of the neural tube, which forms the brain, the spinal cord and their coverings, is partly dependent on the availability of folate (folic acid). Its deficiency in pregnancy increases the risk of neural tube defect.
2. Uncontrolled diabetes – High blood sugar has been noted to interfere with neural tube development.
3. Side effects of medications – Such as antiseizure drugs, certain antibiotics and antimalaria medications.
4. Family history – Those with affected first degree relatives have higher chances of having it.
5. Fever – High body temperature early in pregnancy may increase the risk of spinal bifida

How is spinal bifida treated?

The mild form of spinal bifida (such as spinal bifida occulta) may need no treatment, as it may not even be discovered.

1. Surgery – As the defect in spinal bifida is structural, the treatment is surgical. This may be done while the baby is still in the womb or after delivery. This depends on the anticipated severity and available expertise.
2. Physiotherapy – This involves special exercises done for the baby early in life to prepare the legs for walking. This may help reduce the degree of disability the leg deformity may cause.
3. Supportive therapy – Other associated complications such as poor bladder and bowel control, as well as other challenges will be addressed as they emerge.

How can spinal bifida be prevented?

The following steps may help reduce the risk of spinal bifida:

1. Intake of folic acid – Women of reproductive age who may get pregnant are encouraged to take folic acid (400 microgram) daily. This reduces the chances of a baby developing spinal bifida. Higher dosage (4 milligram daily) is recommended for those who themselves have spinal bifida or have had a child with spinal bifida before.
2. Eating food rich in folate – This include both plant (e.g. green vegetables) and animal sources (e.g. egg yolk)
3. Blood sugar control in women with diabetes – This is important before getting pregnant.
4. Medication control – Only prescribed drugs should be taken in pregnancy. Medications being taken for the management of other medical conditions should be reviewed by a doctor before contemplating pregnancy.
5. Prompt treatment of fever – Fever should be promptly treated with medication while the cause is sought for and treated.