Pathogenesis (development of disease) During embryonic development, the lower section of the neural tube gives rise to the spinal column (lat.: columna vertebralis) and spinal cord (the upper section of the neural tube develops into the brain and skullcap). Normally, the two arch portions of the vertebrae merge to form a ring. In the vertebral … Spina Bifida (“Open Back”): Causes
Conventional nonsurgical therapy methods Catheterization (urinary diversion through a catheter inserted into the bladder) may be used if micturition (bladder emptying) dysfunction is present at the same time. Medication may also be used. Medical aids If applicable, orthotics (orthopedic devices worn on the outside of the body as a support apparatus) for gait development, corsets, … Spina Bifida (“Open Back”): Therapy
A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure, pulse, body weight, height; further: Inspection (viewing): skin, mucous membranes, and sclerae (white part of eye) [local hypertrichosis (increased body and facial hair; without a male pattern of distribution)? Skin retraction over the defect? Teleangiectasias (vascular … Spina Bifida (“Open Back”): Examination
1st order laboratory parameters – obligatory laboratory tests (during pregnancy). AFP screening* (16th to 18th week of pregnancy) or triple test – method of prenatal diagnostics (prenatal diagnostics) in which an attempt is made to draw conclusions about peculiarities in the unborn child on the basis of the concentration of three hormones (AFP (alpha-fetoprotein), HCG … Spina Bifida (“Open Back”): Test and Diagnosis
Obligatory medical device diagnostics. Sonography (ultrasound) in prenatal diagnostics (synonym: fetal sonography; examinations of the unborn child in the womb/prenatal (= before birth)). [Spina bifida can be detected by qualified examiners already in the first trimester (third of pregnancy), i.e. specifically from the 12th week of pregnancy (SSW); otherwise usually in the second trimester between … Spina Bifida (“Open Back”): Diagnostic Tests
1st order Spina bifida aperta: here, the cele (blister-like protrusion; hernial sac) is first incised (sparing the nervous tissue). The spinal cord is gently transferred back into the spinal canal. The spinal canal is closed with a fascial flap. Wound closure is performed in layers or by means of plastic coverage. Myelomeningocele: here, the closure … Spina Bifida (“Open Back”): Surgical Therapy
To prevent spina bifida, attention must be paid to reducing individual risk factors. Behavioral risk factors Diet Folic acid deficiency See below “Prevention with micronutrients”. Disease-related risk factors Diabetes mellitus poorly controlled in the early stages of pregnancy. Medication Teratogenic drugs: Antiepileptic drugs – e.g., valproic acid and carbamazepine. Prevention factors (protective factors) Genetic factors: … Spina Bifida (“Open Back”): Prevention
The following symptoms and complaints may indicate spina bifida: Pathognomonic (evidencing a disease). In spina bifida aperta: open, visible malformation. Possible accompanying symptoms of spina bifida aperta (open, visible form). Walking problems Paresis (paralysis) of the legs Paraplegia Bladder and rectal disorders Hydrocephalus (hydrocephalus; pathological enlargement of the liquid-filled fluid spaces (cerebral ventricles) of the … Spina Bifida (“Open Back”): Symptoms, Complaints, Signs
Medical history (history of illness) represents an important component in the diagnosis of spina bifida. Family history Do congenital malformations run in families? Social anamnesis Current medical history/systemic history (somatic and psychological complaints). What symptoms have you noticed? Nocturnal wetting of the child? Bladder and rectal disorders? Walking problems? How long have these symptoms been … Spina Bifida (“Open Back”): Medical History
Musculoskeletal system and connective tissue (M00-M99). Lumbosacral transitional vertebrae (in the lumbar spine and sacrum). Spondylolisthesis (slippage of a vertebral body).
The following are the most important conditions or complications that may be contributed to by spina bifida: Congenital malformations, deformities, and chromosomal abnormalities (Q00-Q99). Arnold-Chiari syndrome – group of developmental disorders with displacement of cerebellar parts through the foramen magnum (occipital hole) with concomitant reduced posterior fossa into the spinal canal (vertebral canal); type 1: … Spina Bifida (“Open Back”): Complications
