Complications of Spina Bifida

• Ranges from minor physical problems to severe physical & mental disabilities.
• Intelligence level is usually normal.
• Generally all nerves below the malformation are affected.

Severity is determined by

• Size & location of malformation
• Whether or not the skin covers it
• Whether or not spinal nerves protrude from it
• Which spinal nerves are involved

Complications

• Loss of sensation (esp. In lower limbs)
• Paralysis (esp. In lower limbs)
• Loss of normal bowel & bladder control
• Urinary tract infection
• Orthopedic problems (scoliosis, kyphosis, & clubfoot)
• Lipomeningocele
• Spinal cord tethering
• Chiari II malformation
• Hydrocephalus
• Meningitis
• Learning disabilities
• Latex allergies
• Gastrointestinal conditions
• Depression
• Obesity

Bladder complications

• Early catheterization to preserve kidney & bladder functions
• Further complicated by
  
  • Bladder stones
  • Bladder ruptures
  • Bladder tumors

Lipomeningocele

• Congenital lesion that is associated with spina biida
• Associated with abnormal fat accumulation that starts below the level of the skin & extends through the bony opening to the spinal cord
• Females are 50% more likely to develop lipomeningocele
• Damage is due to
  
  • Tethering of spinal cord
  • Compression due to progressive deposition of fat
• Signs & Symptoms
  
  • Obvious soft tissue swelling over the spine in the lumbosacral region in more than 90% cases
  • Lesion is covered by skin & painless
  • Weakness (symmetrical/assymetrical)
  • Bladder & bowel incontinence
  • Pain of variable quality may be significant in adolescence & adulthood (esp. Radiation)
  • Loss of back mobility
• Diagnosed with MRI
• Managed with surgery

Spinal cord tethering

• Literally low-lying spinal cord
• Spinal cord remains attached to the surrounding skin, causing abnormal growth
• Spinal cord becomes stretched & damaged
• Results in
  
  • Progressive neurological, urological, or orthopaedic problems
• Managed with surgery
• Preventive strategies disappointing

* Chiari I malformation

• Occurs when the lowest part of the cerebellum (cerebellar tonsils) descends a short distance into the cervical spine
• No involvement of the brain stem
  

Chiari II malformation (Arnold-Chiari malformation)

• Usually a rare condition
• Common in children with myelomeningocele
• Extension of both brainstem & cerebellar tissues into the foramen magnum
• Cerebellar vermis (tissues connecting both cerebellum hemispheres) may only be partially present
  
• Leading cause of death in the spina bifida population
• Results in
  
  • Spinal cord compression
• Signs & Symptoms
  
  • Difficulties with feeding, swallowing & breathing
  • Choking
  • Arm stiffness
• Complications
  
  • Blockage of cerebrospinal fluid – HYDROCEPHALUS
• Diagnosed with MRI
• Managed with surgery

* Chiari III malformation

• Occurs when the cerebellum & brainstem herniate through the foramen magnum & into the spinal cord
• Part of the brain's fourth ventricle may also be involved
• Rare instances of associated occipital encephalocele
  

* Chiari IV malformation

• Occurs when there is incomplete or underdeveloped cerebellum (cerebellar hypoplasia)
• Cerebellar tonsils are located further down the spinal canal
• Parts of cerebellum are missing
• Portions of skull & spinal cord may be visible
  

Hydrocephalus

• An abnormal buildup of cerebrospinal fluid in the brain
• Excessive buildup places damaging pressure on the brain
• Managed by ventriculoperitoneal shunt insertion to drain cerebrospinal fluid

Meningitis

• Infection of the meninges
• Potentially cause brain injury
• Potentially fatal

Learning disabilities

• Difficulty paying attention
• Problems with language & reading comprehension
• Trouble learning mathematics
• Perceptual motor problems (poor eye-hand coordination & ineffective motor skills)
• Hyperactivity/Impulsivity
• Poor memory
• Poor organization
• Problems in sequencing tasks
• Difficulty in decision making/problem solving