The nervous system is one of the first components that begins to develop during our development, when we are still fetuses. Throughout the first month of pregnancy, in fact, already the neural tube that will configure our brain and spinal cord begins to close.

They will be surrounded and protected by the skull and spine. However, in some cases a malformation occurs that prevents the neural tube and the spinal column from closing, remaining open to some degree so that the nerve bundles it contains can suffer various damages and injuries. We are talking about spina bifida .

What is spina bifida?

We understand spina bifida as a type of malformation produced during fetal development in which part of the neural tube does not close completely during the first month of pregnancy, so that the spine does not fully protect the nerves that run down through it and the cord is exposed to injuries and damage of varying severity. Sometimes this opening remains visible, although in other cases it is hidden by the skin.

Spina Bifida may not generate symptoms in some cases, but depending on the type of malformation, its location and the existence of possible damage to it, severe problems can be generated that are dangerous for the subject. The closer the opening is to the brain, the greater severity of the symptomatology as more nerves are damaged.

Some of the typical symptoms of subjects with spina bifida, specifically due to the presence of lesions in the spine due to this malformation, may be the presence of gastrointestinal alterations, lack of control of the sphincters and the urethra, weakness and lack of sensitivity of the lower limbs or the areas located below the lesion and it is even possible that there is total paralysis of these areas.

It must be taken into account that in some cases the opening of the neural tube is very close to the skull and may generate alterations such as hydrocephalus or meningitis, with a risk of mortality for the affected person. Learning problems and even intellectual disability may occur in some cases.

Types of spina bifida

Spina bifida is a problem that can present itself in different ways, so it is possible to establish different subtypes depending on its characteristics.

1. Occult spina bifida

This is the form of presentation with the least impact on the subject, and is the most common form of manifestation of spina bifida.

In this case one or more vertebrae have not formed correctly and may have openings, although the nerve tissue remains inside. The malformation is hidden by skin. The subject may have holes or protrusions in the back . It does not usually cause serious disabilities, but there may be deformities, incontinence, insensitivity in one of the extremities or weakness.

2. Cystic or open spina bifida

In this type of spina bifida, part of the spinal cord or the meninges protrude outside the vertebrae, with a high level of danger to the subject who suffers from them as the nerve material protrudes and is not protected. These usually form a sac filled with cerebrospinal fluid and the protruding material that can be observed externally.

Within this type we can find two subtypes .

Meningocele

In this case, we find a malformation in which the meninges of the spine protrude , and the lesion may be exposed or protected by the skin. However, what protrudes is only the meninx and cerebrospinal fluid, with the nerve bundles still inside the spine.

Mielomeningocele

This is the most severe form of spina bifida . In it the spine is exposed and protrudes through the opening of the spine. In other words, the bundles of nerve fibres have no bone protection, but are exposed on the outside of the spine. This can lead to severe paralysis, preventing bipedal locomotion and loss of sensation and strength in the innervated areas.

Possible causes

Spina bifida is a congenital, although not inherited, condition . Although the elements and mechanisms that cause the neural tube to fail to close are unknown, it is an alteration that occurs during the individual’s fetal development, and is usually associated with the presence of low levels of folic acid during pregnancy. There is also speculation about the possibility of some kind of genetic influence.

There are other elements that may be risk factors , such as the use of certain psychotropic drugs during pregnancy (for example, valproic acid), the presence of high fevers during pregnancy, or the age at which pregnancy begins (adolescents and very old people may be at greater risk).

Treatment

Spina bifida is a disorder that has no fully curative treatment , at least as far as the damaged nerves are concerned. However, it is possible to perform various types of surgery that allow the neural matter to be replaced and protected.

In the case of subjects with occult spina bifida, treatment may not be necessary (in fact, in many cases it is not detected until advanced age). Although there may be problems with anchoring the spine that can cause problems during growth. In this case surgery would be necessary .

In cases of open or cystic spina bifida, an intervention is necessary. In the case of myelomeningocele it is necessary to close the tube and protect the neuronal bundles . At present, it is possible to carry out the intervention even in the foetal stage, so that the problem is corrected before birth in such a way as to avoid more damage than that which already exists, although these are treatments that can pose a certain danger to both the foetus and the mother.

Other spine or bone problems resulting from spina bifida may require treatments and surgeries beyond those described above. In cases with hydrocephalus, excess spinal fluid must also be treated.

Pregnancy prevention

Another way to avoid this problem is through prevention. It is recommended that during pregnancy the mother-to-be should incorporate folic acid into her diet, or take supplements from it.

Special caution is needed with teenage or very old mothers, and in the case of a person with epilepsy taking valproic acid consult your doctor or psychiatrist about possible effects of this medication or the possibility of using other anticonvulsants as an alternative.