SPINA BIFIDA

DEFINITION
• Broadly used term
• Congenital problem in which there is a defective closure of the vertebral column.

ETIOLOGY
• Unsure of cause, but current theory links this occurrence to decreased amounts of
Folic Acid in the mother during pregnancy.
• (0.4mg/day) – Cereals now fortified with FA – Green leafy vegetables
• 21 day inutero vertebral column grows together

DIAGNOSIS
• Increased levels of alpha-fetoprotein (AFP) in the amniotic fluid can indicate the
presence of Spina Bifida. Can be diagnosed in utero
o Elevated levels HIGH risk for SB
o Test usually done at 16-18 weeks
o Decreased may be Downs Syndrome
o MRI, Ultrasound, CT, Myelography
o Amniocentesis with 2+ AFP test

TYPES
• Occulta
o Not visible – Externally (L5, S1) Minor with small opening extra hair/skin/different
o Exercise, limit activities – Adulthood may have back problems. Spinal cord not
involved
• Meningocele
o Not associated with neurologic deficits(Meninges / Spinal fluid)
o Surrounded with thin, fragile skin. Increased R/F Meningitis (transillumination)
o Protrudes out of the skin but no nerve roots are involved.
o CANNOT BE BORN VAGINALLY
• Myelomeningocele
o Meninges, Spinal fluid, nerves.
o C-Section
o WORST TYPE – Patient at spine have deficit (Usually Lumbar / Sacral) bowel /
bladder problems. Decrease in extremity with deformed position form waist down
o Most all children with this type will have bowel and bladder problems and see
them in a wheelchair. It all depends on where the injury occurs.
o Problems are at the waist down
o A majority of these children born with this type of SB will have Hydrocephalous
 Because this started at 28 days in utero.
 The spinal fluid has trouble flowing; it backs up in the ventricle where it is
made.
o When born with this type of SB; within the first 24 hours they are taken to surgery
o Very individualized treatment
o Because they are at great risk for INFECTION. MENINGITIS.
• Cystica
o Meningocele – least severe – spinal cord not involved
CLINICAL MANIFESTATIONS
• Sensory disturbances (Par to Pt spine)
• Bowel and bladder dysfunction
• Motor dysfunction (Possible partial paralysis)
• Joint deformities
• Increased Latex allergies – possible due to increased hospitalization
• Food allergies

TREATMENT
• Need to be prepared at birth and be in an appropriate facility
• Immediate surgery (1st 24 hours because of increase risk for meningitis)
• Cover sac with moist rag, careful not to rupture
• Life-Long follow up and care for Myelomeningocele
• Individualized with very aggressive treatment
• The hydrocephalous may cause some mental problems. But may be normal
• Mainstreamed in school; In and Out Cath

NURSING DIAGNOSIS
• High R/F infection (SAC)
• High R/F neurologic trauma (Hydrocephalus)
• High R/F impaired skin integrity
• Altered family process
• High R/F impaired parent-infant attachment
• Altered bowel / bladder function

MYLO BED: Prone with foam straddle keeps on stomach; align lower extremities