Spina Bifida

1. Pathophysiology

1.1. -occurs between 17th & 30th day of gestation -many women are unaware of pregnancy & may be exposed to teratogens -lumbosacral end of spinal cord is uncovered and exposed in a sac above the skin -leads to dysfunction of spinal nerves at & below level of defect -obstructed flow of CSF can lead to hydrocephaly -cerebral & cerebellar effects

2. Diagnostic Tests

2.1. -maternal blood tests 16-18 weeks into gestation: elevated alpha-fetoprotein (AFP) -amniocentesis: AFP & acetylcholinesterase

3. Treatment

3.1. -potential for fetal surgery -close spinal defects STAT post-delivery to prevent infection & additional loss -correctional surgery for tethered cord -shunt placement surgery -assistive devices -bladder catheterizations/ bowel management regimens -therapy for immobility

4. Why?

4.1. I have the privilege of caring for a little boy with spina bifida. He is now 8 years old, and I have spent a considerable amount of time with Jordan and his family. I was interested in learning more about his condition as well as understanding the complications that he deals with. I hoped that with some more research and knowledge, I would be able to better care for him as well.

5. Resources

5.1. Capriotti, T., & Frizzell, J. P. (2016). Pathophysiology. Introductory concepts and clinical perspectives. Philadelphia, PA: F. A. Davis Company. National Institute of Neurological Disorders. (2018). Spina Bifida Fact Sheet. Retrieved from Spina Bifida Fact Sheet | National Institute of Neurological Disorders and Stroke

6. Signs & Symptoms

6.1. -born w/ exposed neural tissue in lumbosacral region -lipoma, dimple, pigmentation, or hair patch on lumbosacral back -hydrocephaly -anencephaly -flaccid paralysis & lack of sensation on lower extremities -spastic paralysis of upper extremities -scoliosis, lordosis, & other musculoskeletal abnormalities

7. Causes & Risks

7.1. -maternal folate deficiency -trisomy 12, 18, & 21 -maternal diabetes -maternal obesity -maternal hyperthermia -maternal anti-seizure meds -first month of pregnancy -maternal spina bifida

8. Long Term Complications/ Associated Conditions

8.1. -related to size & location of malformation; covered/noncovered; spinal nerve involvement -Chiari II Malformation—difficulty with feeding, swallowing, and breaking control -meningitis -increased ICP/ excess CSF -paralysis or decreased strength of the lower limbs -decreased bowel & bladder control -latex allergy -depression

9. Definition

9.1. DEFINITION: “Cleft Spine” characterized by improper/ incomplete development of spinal cord. There are three types of Spina Bifida: -occulta—least severe form; opening in vertebrae dimple, skin hyperpigmentation, or patch of hair on back -meningocele—opening in vertebrae with meninges protruding -myelomeningocele—opening in vertebrae with meninges and part of spinal cord protruding most severe symptoms