spina

• Spina bifida(latin = split or open spine)


  • Birth defect occurs when the spinal cords fails to form properly
  • Can occur anywhere along the vertebral column
  • Most common at lumbar or sacral portion of the spine
• Types of spina bifida


  • Spina bifida occulta
  • Spina bifida cystica: Meningocele, Myelomeningocele
• Spina bifida occulta


  • Hidden Spina Bifida
  • Covered neural tube defect
  • 15% of patients
  • RARE neurological problems
• Meningocele


  • Only spinal fluid in sac
  • No nerve tissue
  • Few or no symptoms to paralysis
• Myelomeningocele


  • Most severe
  • Both fluid and nerve tissue in sac
  • Exposes nerves
  • Partial or complete paralysis
• Clinical manifestations of spina bifida based on location of defect

  • Thoracic level (paralysis of the legs, weakness and sensory loss in the trunk and lower body region)
  • Lumbar 1 - 2 level (some hip flexion and adduction, cannot extend knees)
  • Lumbar 3 level (can flex hips and extend the knees; paralyzed ankles and toes)
  • Lumbar 4 - 5 level (can flex hips and extend the knees; weak or absent ankle extension, toe flexion, and hip extension)
  • Sacral level (mild weakness in ankles and toes)
• Complications of spina bifida

  • Sensory loss more pronounced on the back of the legs
  • Loss of lower extremity motor and sensory functioning may not be symmetric
  • Bowel and bladder incontinence
  • Renal damage
  • Hydrocephalus
• Spina bifida diagnosis


  1. Clinical manifestations and examination of meningeal sac

  2. MRI

  3. Ultrasonography

  4. CT scan

  5. Neurologic evaluation

  6. Prenatal diagnosis: AFP, MS-AFP (16 - 18 weeks AOG)
• Spina bifida prevention


  • Increase folic acid in DIET: Whole grains, Fortified breakfast cereals, Dried beans, Green leaf vegetables and fruits
• Spina bifida management


  1. Surgical repair (within 24 to 72 hours after birth)

  2. If sac is leaking, surgical closure within the first 24 hours

  3. VP-shunt procedure

  4. Mitrofanoff procedure

  5. Antibiotic therapy (if associated with infections)

  6. Braces

  7. Assistive devices

  8. Diet (adequate calcium and vit. D/dietary fiber)

  9. Weight bearing activities

  10. Clean intermittent catheterization (every 3-4 hours)

  11. Stool softeners and glycerin or bisacodyl suppositories/ Enema
• Spina bifida nursing considerations

  • Assess the sac and measure the lesion
  • Assess neurological system
  • Measure head circumferences
  • Protect the sac, cover with a sterile, moist (normal saline), nonadherent dressing and change the dressing every 2-4 hours
  • Place patient in prone position and head to one side
  • Assess and monitor the sac for redness, clear or purulent drainage, abrasions, irritation, and signs of infection
  • Administer medication: antibiotics, anticholinergics, and laxatives as prescribed
• Spina Bifida Cystica

  Visible Defect with external sac like protrusion

  
  

  2 kinds:

  Meningocele

  Myelomeningocele