Spina Bifida (Open Back)

Spina bifida (open back) is a malformation of spinal cord and spinal column. Since the spinal column and spinal cord in the embryo develop out of what is known as the neural tube, spina bifida is called a neural tube defect. Neural tube defects are the second most common congenital malformation after heart defects. An open back occurs more frequently in the area of the lumbar spine and sacrum than in the area of the thoracic or cervical spine.

There are various forms and severities of spina bifida:

  • Open spina bifida (spina bifida aperta)
  • Concealed spina bifida (spina bifida occulta)


Causes

The causes of spina bifida are not yet explained exactly. It has been established that the malformation of the spinal cord occurs during the third to fourth week of pregnancy. This is because the embryo's neural tube fails to close. The neural tube is an early stage in the development of the central nervous system. The lower section of the neural tube develops into the spinal cord and spinal column, while the upper section becomes the brain and skull.

A lack of folic acid (a B vitamin) or a disturbed folic acid metabolism during pregnancy is considered a common cause of spina bifida. Women who take anti-epileptic drugs during pregnancy due to epilepsy have an approximately one percent higher risk of open spinal cord development in their baby.

Symptoms

The symptoms can vary widely. Whether and how severely the malformation affects the spinal column region depends on where exactly the fissure has formed. Spina bifida occulta is sometimes completely asymptomatic. While the vertebral arch is split in two, the spinal cord is not affected. Therefore the malformation often remains undetected. An open back on the other hand, where the spinal meninges and/or spinal cord are also split, can have minor to severe consequences. Known as spina bifida aperta, the symptoms range from almost unnoticeable complaints to severe limitations such as paraplegia.

Therapy

Therapy depends on the severity of the spinal malformation. In some cases, the minor form of the malformation requires no treatment at all. Spina bifida aperta on the other hand may be associated with a severe defect. Surgical intervention within 48 hours of birth is indicated in such cases. Treatment with physiotherapy as well as orthopaedic devices such as orthoses can be helpful in order to counteract joint deformations as a result of spina bifida.


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