Complications
associated with spina bifida
Treatment
A shunt (thin tube) can be implanted to drain the fluid into the abdomen. This may require further surgery if the tube becomes blocked or infected or if the child grows out of it and needs a larger one.
School support
The majority of children with spina bifida have normal intelligence and can attend school without additional support. However in cases where learning disabilities are present, additional support can be offered.
Hydrocephalus is a build-up of fluid in the brain. The excess fluid puts pressure on the brain, which can damage it. If left untreated, hydrocephalus can be fatal. Congenital hydrocephalus is when a baby is born with excess fluid in their brain and will more likely have permanent brain damage.
This can cause several long-term complications, such as:
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speech problems
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memory problems
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short attention span
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problems with organisational skills
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vision problems, such as a squint and vision loss
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problems with physical coordination
Hydrocephalus
Normal
Hydrocephalus
Blocked flow
Excess cerebrospinal fluid in ventricles
increased head size
Meningitis
It has been found that those with spina bifida have a higher risk of developing meningitis, an infection of the protective membranes that surround the brain and spinal cord (meninges). This infection leads to inflammation and can cause a multitude of problems such as hearing and vision loss, brain damage, memory problems, seizures or arthritis. In severe cases, it can lead to death.
skin
fat
skull
dura mater
brain
pia mater
arachnoid
Chiari malformation
There are 4 main types of chiari malformation, but spina bifida is the cause for type 2. The cerebellum is responsible for controlling balance and motor control and is located at the lower back of the brain. In chiari malformation, this part can extend down into the spinal canal. Pressure on the brain stem can then lead to problems such as breathing, swallowing and weakness in the arms.
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Normal
The cerebellum has extended down through the foramen magnum (the hole in the bottom of the skull) and has increased pressure on the brainstem.
Bowel and bladder problems
When the spinal cord doesn't form properly and nerves become damaged, it is likely that those with spina bifida can experience bowel and bladder complications. It is thought that loss of innervation to pelvic floor muscles and hindgut may be the cause for constipation and nerves that control the bladder often do not form properly and result in problems storing and passing pee.
Large intestine
Kidneys and bladder
Bowel
treatment
Bowel issues such as constipation can be a recurring problem for those with spina bifida.
- Laxitives and enemas can help empty bowels and relieve constipation
- Anal irrigation is when water is used through a tube to clean out the bowels
- Antegrade continence enema (ACE) is where a passage can be made between the bowel and surface of the abdomen so liquid can be pushed through and stool can be flushed out through the bottom
- Colostomy is where the bowel is brought through an opening in the abdomen and a pouch is placed over to collect the stool.
Bladder
treatment
Some people with spina bifida may have trouble with their urinary bladders. There are a range of treatments available including:
- Lifelong antibiotics to prevent urinary and kidney infections
- Medicines that help relax the bladder so it can store more
- An intermittent urinary catheter can help to drain urine from the bladder during the day
- Bladder surgery can involve enlarging the bladder or using the appendix to connect the bladder to an opening on the abdomen for easier catheter insertion.
Tethered cord syndrome
Many people with open spina bifida have tethered spinal cords. It is a condition in which the spinal cord becomes attached to the spinal column via surrounding structures. Normally, the spinal cord hangs loose in the canal, freely bending and stretching and moving up and down as the body grows. However, a tethered spinal cord does not move; it is pulled tightly at the end. This reduces blood flow to the spinal nerves and damages the spinal cord from the stretching and the decreased blood supply.
Normal position of spinal cord
Normal spinal cord
Spinal cord is stuck to the spinal canal
Tethered cord syndrome
The study found that by adulthood, no patients had independent ambulation who had a lesion between L1 - L3.
Lesions found L5 or below resulted in over 90% of patients able to move freely and unaided.
Physiotherapy
Physiotherapy is a way of helping those with spina bifida become independent. Exersise can help strengthen muscles and it can also help to prevent deformity. Walking aids or splints can be used to offer support in moving around.
Mobility
Paralysis
In myelomeningocele, the spinal cord can become damaged when it's exposed. This can result in muscle weakness, loss of sensation or paralysis. The affected level of mobility can mean using walking aids or a wheelchair to assist in everyday living.
A study carried out found that the location of the lesion on the spine can greatly impact the level of independent movement in adulthood.
Corrective orthopaedic surgery can often be needed in those who have bone deformities such as club foot or hip dislocation. People who are unable to use their legs will usually need a wheelchair. Electric ones are available but manual ones can maintain upper body strength. Having weak leg muscles can be helped with the use of walking aids or leg braces.