Spina bifida literally means split spine. It is one
of the most common birth defects involving the nervous
system and occurs between 14-28 days of fetal development.
When one or more of the vertebrae (bones which make
up the spine) fail to fuse in the middle, the spinal
cord gets damaged. The meninges, the membrane which
covers the spinal cord, protrudes through the hole
in the spine instead of growing down the spinal column.
Typically spina bifida occurs at the baby's waistline.
Three types of Spina bifida
1. There are three types of spina bifida. Spina bifida
occulta (which means hidden) is fairly common. Majority
of such babies go on to have no problems whatsoever
after birth and therefore require no treatment. Signs
include a dimple on the skin, hair growth or a birth
mark in the small of the back
2. The second type, spina bifida myelomeningcocele
is the most serious of the three. The membranes meant
to cover and protect the spine form a fluid-filled
sac in the small of the back to contain both the meninges
and the cerebrospinal fluid. It pushes through the
hole in the vertebrae and is clearly visible at birth.
Because of the damaged spinal cords these babies typically
have hydrocephalus and paralysis in varying degrees.
Surgery is performed within a day or two after birth
in the more severe cases and during some point of
infancy for the less serious cases.
3. The last type is the meningcocele. Here too the
sac forms which contains just the cerebrospinal fluid.
The damage is less severe than the second type.
Checking for Spina bifida
1. There are two ways to detect spina bifida. One
is to check on the levels of alpha-fetoprotein (AFP)
in the mother's blood. Alpha-fetoprotein is one of
the 3 components of the triple test commonly performed
at bout 14 weeks of pregnancy. A raised level of AFP
is indicative of an increased risk of spina bifida
and the mother will be offered further scanning. The
protein, AFP made in the baby's liver can seep from
a break in the baby's skin and into the mother's blood,
which is detected in the test. The leakage results
in a much higher level of AFP than the expected level
in the amniotic fluid.
2. Second, ultrasound at 18 weeks can detect most
cases of spina bifida as the features of abnormality
in the spine and brain are obvious during the study.
• Spina bifida is a congenital disorder of the
neural tube; there is an opening in the spinal cord
and the spinal column (backbone) of the developing
• The neural tube is a structure that forms
as a fold of tissue from which the fetus's brain and
spinal cord develop.
• The neural tube begins to develop about 10
days after conception and its development continues
6 weeks of gestation this fold closes into a tube.
If it does not close properly, severe birth defects
can result, with spina bifida being one of them.
• Many babies born with the severe form of spina
bifida also have hydrocephalus (literal meaning is
water in and around the brain). This is caused by
the abnormal circulation of the cerebrospinal fluid.
The increased pressure inside the skull can damage
the brain cells. A procedure to place a shunt inside
the brain will be necessary to help drain the excess
• The location determines the severity of the
defect. The higher the position of the defect on the
spine, the greater the intensity of the complication.
• Because the spinal cord is not enclosed in
the backbone, the infant has a high risk for meningitis,
a serious infection of the spinal fluid, brain, and
the lining covering the brain and spinal cord.
• Generally there is a loss of body functions
below the level of the opening in the spinal cord.
In the more severe cases, the child will have permanent
problems with urination and defecation, experience
paralysis and face learning disabilities
• Surgery soon after birth can prevent further
deterioration. Newer surgical methods are being introduced
to correct the problem while the fetus is still inside
• There is no cure to spina bifida. Surgery
at best will repair the opening by pushing the meninges
and closing the hole in the vertebrae. Surgery will
not change the loss of function. Children with spina
bifida often do not walk unassisted and frequently
have learning disabilities. Despite this, with corrective
measures or aids, many children with spina bifida
grow up to live productive lives.
Prevention of Spina Bifida
Deficiency of folic acid in the mother appears to
be an important factor in the development of spina
bifida. Studies reveal that adequate amounts of folate
or folic acid (synthetic form of folate) can reduce
the incidence of neural tube defects by up to 70%.
However folic acid can only prevent the spinal and
brain defects in the very early stages of pregnancy.
That makes folic acid before conception and in the
first 3 months of pregnancy all the more necessary.