Diagnosis of spina bifida

Spina bifida occulta is usually a random finding on X-ray. A secondary dermal sinus (Sinus pilonidales) is conspicuous due to the bulging of the skin and the increased hairiness of this area. However, prenatal ultrasound examinations are decisive in the diagnosis of spina bifida.

This malformation can already be detected by sonography in the womb. In the mother’s amniotic fluid, a protein can be determined which can provide information about the development of the child: alpha-fetoprotein (AFP). If the child is born with such a defect, MRI (magnetic resonance imaging) can help to identify the exact extent of the malformation.An MRI (magnetic resonance imaging, nuclear spin) of the lumbar spine (lumbar spine) is usually not necessary if spina bifida is suspected, since normally only the spina bifida aperta causes problems and this is normally already visible to the naked eye.

Often this can be detected in ultrasound examinations before the child is born. Nevertheless, it can be useful to have an MRI to see exactly whether the spinal cord is also located in the skin sac (hernial sac) of a spina bifida aperta. Otherwise, an MRI is only advisable if the symptoms are unclear (such as certain foot malpositions in the newborn/baby), which can be associated with spina bifida.

This can be used to assess whether spina bifida, which usually occurs in the lumbar or sacral region, is present. Even if certain other abnormalities, such as a dermal sinus, are present, an MRI can be performed to assess the exact anatomy of the disorder present. An MRI of the pregnant woman may be more useful to clarify ambiguous ultrasound examinations. These are usually considered from the 19th week of pregnancy.

Therapy of spina bifida

Spina bifida aperta should be surgically closed as quickly as possible to prevent the entry and rise of germs and thus prevent infections of the nervous system. Surgery significantly improves the chance of survival, but consequential damage cannot always be ruled out. In long-term care, it is particularly important to avoid complications.

As a rule, lifelong medical care is necessary. In the case of hydrocephalus (hydrocephalus), the draining of excess nerve fluid is of great importance. For this purpose, a shunt is placed, which drains the spinal fluid. A shunt is an artificially implanted channel. This shunt can drain the liquor into the atrium or the abdominal cavity.