Spina bifida is a defective closure of the spine. Although the cause is not known, a low folate levels may increase the risk during pregnancy. Some cases are asymptomatic, others have severe neurological deficits below the lesion. can bifida an open spina prenatally diagnosed with or suspected sonography by increasing the ?-fetoprotein in the maternal serum or amniotic fluid. After birth, the lesion is usually visible on the back. The treatment is surgery usually.
Spina bifida is one of the heaviest with another life agree neural tube defects. This defect is, overall, one of the most common congenital abnormalities with an incidence of about 1 in 1,500 in the United States. It is most commonly observed in the lower thoracic, lumbar or sacral region and expands over 3-6 vertebral segments. The severity ranges from the closed type with few signs to the fully open spine (rachischisis) with severe neurological impairment and the child’s death.
Spina bifida is a defective closure of the spine. Although the cause is not known, a low folate levels may increase the risk during pregnancy. Some cases are asymptomatic, others have severe neurological deficits below the lesion. can bifida an open spina prenatally diagnosed with or suspected sonography by increasing the ?-fetoprotein in the maternal serum or amniotic fluid. After birth, the lesion is usually visible on the back. The treatment is surgery usually. Spina bifida is one of the heaviest with another life agree neural tube defects. This defect is, overall, one of the most common congenital abnormalities with an incidence of about 1 in 1,500 in the United States. It is most commonly observed in the lower thoracic, lumbar or sacral region and expands over 3-6 vertebral segments. The severity ranges from the closed type with few signs to the fully open spine (rachischisis) with severe neurological impairment and the child’s death. In the occult spinal Dysrhaphie (OSD) can malformations of skin that covers the lower back (typically the lumbosacral area) happen. This includes fistulas, have no visible end, but above the lower sacral area or not in the middle line, hyperpigmented locations asymmetry of Glutealspalte, wherein the upper edges to one side differ, and hairy bodies (lanugo) a. The children often have abnormalities of the underlying part of the spinal cord as lipomas and chain formation, in which the spinal cord attached pathologically ist.- forms of spina bifida .. as spina bifida cystica referred to a bulging sack of the meninges (meningocele), spinal cord ( myelocele) or both (myelomeningocele) contains. In the myelomeningocele the bag consists of the meninges with a central neural structure. If he is not well covered with skin, the bag can tear easily. This leads to an increased risk of meningitis. Forms of spina bifida. In the occult spinal Dysrhaphie more than one vertebrae are not formed normally, and the skid marks and the meninges may also be affected. As spina bifida cystica referred to a bulging sack of the meninges (meningocele), spinal cord (myelocele) or both (myelomeningocele) contains. Hydrocephalus is often because many children to Chiari malformation type II have (hydrocephalus). Syringomyelia (a dilatation of the usually small fluid-filled central canal of the spinal cord syrinx of the spinal cord or brain stem) and other congenital abnormalities and soft tissue lesions around the spinal cord may be present. Etiology The causes seem to have many factors. Folic acid deficiency is an important factor, and there seems to be a genetic component. Other risk factors include multiple pregnancy, taking certain medications (eg. Valproate example) and maternal diabetes. Symptoms and complaints Many children with minor defects are asymptomatic. Neurological Symptoms When the spinal cord or the lumbosacral plexus are affected, occur differently severe paralysis of the affected muscles and sensory disturbances below the lesion. The rectal tone is reduced in general. Hydrocephalus (hydrocephalus) may cause minimal symptoms or signs of increased intracranial pressure. A brainstem involvement can cause symptoms such as wheezing, difficulty swallowing and intermittent apnea symptoms zeigen.Orthopädische The lack of muscle innervation leads to atrophy of the legs and decreased rectal sphincter tone. Since the paralysis occurs in the fetus, can be present at birth already orthopedic problems (eg. As club foot, arthrogryposis of the legs, dislocated hip Congenital malformations of the hip, legs and feet). Kyphosis can sometimes be present, contrary to a surgical closure and prevent the child can lie on his back. Scoliosis can develop later and is more common in children with higher lesions (i. E. Via L3) .Urologische symptoms Paralysis can also affect bladder function and lead to vesicoureteral reflux with hydronephrosis, frequent urinary tract infections and ultimately renal damage. Diagnostic ultrasound or MRI imaging techniques for the spinal cord with ultrasound or MRI are essential in children with OSD; even children with minimal skin findings have underlying spinal anomalies. The cases with obvious defects do not require imaging techniques because the anatomy is known. X-rays of the spine, hips, and if they are faulty, the lower extremities are performed. Cranial imaging using ultrasound, CT and MRI is used to detect a hydrocephalus and syringomyelia. If the diagnosis is made spina bifida, an examination of the urinary tract including urinalysis, urine culture, determination of creatinine and urea and ultrasound is necessary. The determination of the bladder capacity and pressure, flows back in the urine in the ureters can decide on prognosis and necessary interventions. Other tests such as urodynamics and a voiding cystourethrogram depend on the preliminary investigations and the associated malformations. Prenatal screening methods can screening by ultrasound and by examination of the maternal serum levels of ?-fetoprotein (Non-invasive screening of the mother serum screening mother to neural tube defects) done, ideally 16 to 18 weeks gestation. The mirrors can also be created with amniotic fluid samples, if a previous test suggests an increased risk. Elevated levels suggest an increased risk of spina bifida cystica. OSD rarely causes elevated levels. Prognosis The prognosis depends on the level of spinal cord involvement and the number and severity of malformations. The prognosis is worst for those children who have a high spinal cord involvement (thoracic) or kyphosis, have hydrocephalus, an early hydronephrosis and associated malformations. However, most children with good supply thrive. The loss of renal function or ventricular shunt complications are usually the cause of death in the elderly. Treatment Surgical correction of spinal cord Sometimes a ventricular shunt Various measures for orthopedic and urologic complications Without rapid surgical intervention may progress of neurological damage. The treatment for spina bifida species requires from the beginning a team work of specialists from several disciplines: neurosurgery, urology, orthopedics, pediatrics, psychiatric / mental health care and social services. It is important, the type, the spinal segment and the extent of the lesion, to determine the health status of the infant and the associated defects. One should support the family, talk to her and clarify their strengths, needs and resources, and the possibility of long-term care. If a myelomeningocele detected at birth, it is immediately covered with a sterile cloth. If the myelomeningocele loses no cerebrospinal fluid, antibiotics are given to prevent meningitis. A neurosurgical correction of the myelomeningocele or an open spine is carried out within the first 72 hours in order to reduce the risk of meningeal or ventricular infection. If the defect is very large or located at a difficult place, plastic surgeons should be consulted to ensure an adequate seal. Hydrocephalus may require a shunt procedure in the neonatal period; sometimes a ventricular shunt is used when the seat is operated (hydrocephalus: therapy). Renal function should be closely monitored, and a urinary tract infection should be treated immediately. Obstructive uropathy either bladder outlet or at the height of the ureters must be aggressively treated to prevent infection. If children from 2 to 3 years of age, or if they have increased pressure in the bubble with vesicoureteral reflux is catheterized to empty the bladder regularly. The catheterization increases the continence and maintains the health of the bladder and kidney. At the same time children are placed after meals to the pot or the toilet to promote the fecal continence. A balanced diet should be supported; Stool softeners, laxatives, or a combination may be helpful to ensure regular bowel movements and improve continence (fecal incontinence in children: treatment). In older children, an antegrade colonic enema procedure in which a hole is placed through the abdominal wall into the intestine to allow the infusion of fluids, improve continence. The hole is through an open tube (eg. For example, a nasogastric tube) kept open. The orthopedic treatment should begin early. If a club foot is present, a plaster is used; an operation thereafter is often necessary (congenital malformations of the hip, legs and feet: pes equinovarus). Also hip dislocation are clarified. Affected children should be examined for the development of scoliosis, pathological fractures, pressure ulcers, muscle weakness and spasm. Prevention Folic acid supplementation (400-800 micrograms p.o. once daily) in women three months before conception and during the first trimester of pregnancy, the risk of a neural tube defect reduced (Congenital neurologic abnormalities at a glance: Prevention). those at high risk of neural tube defects is believed d women. H. Women who have had a fetus or an infant with a neural tube defect should folic acid 4 mg (4.000 ug) p.o. Take 1 times a day. Important points spina bifida includes a closing defect of the spine, sometimes with a bulging sack of the meninges (meningocele), spinal cord (myelocele) or both (myelomeningocele) contains. Chiari II strain, often caused hydrocephalus often occurs. Folate deficiency is a major risk factor, but other factors include maternal use of certain drugs (such. As valproate), maternal diabetes and may have a genetic component. Children with minor defects are asymptomatic, but other children usually have a paralysis of varying severity and sensory disturbances below the lesion. The lack of muscle innervation leads to atrophy of the legs and orthopedic deformities. Prenatal screening with fetal ultrasound and maternal serum levels of ?-fetoprotein is made. The Rückenläsion is repaired, a shunt is placed for symptomatic hydrocephalus and the orthopedic and urologic abnormalities are treated as needed. The prevention via folic acid substitution.