65. Closure abnormalities of the spinal cord

• Spinal dysraphism is an umbrella term for conditions caused by abnormal closure of the neural plate
• The most important cause is maternal folic acid deficiency during pregnancy
• Types
  • Closed spinal dysraphism (spina bifida occulta)
    • Asymptomatic
    • Due to incomplete closure of vertebrae
  • Open spinal dysraphism (spina bifida cystica)
    • Meningocele – herniation of meninges
    • Myelomeningocele – herniation of meninges and spinal cord
• Treatment
  • Antibiotic prophylaxis from birth to surgery
  • Surgical closure
    • Within 72 hours of birth
  • Postoperative monitoring for hydrocephalus
    • If it develops, place a ventriculoperitoneal shunt
  • Regular follow-ups throughout life
• Prognosis
  • Nearly all patients with myelomeningocele develop neurogenic bladder and faecal incontinence
  • Many develop orthopaedic problems like scoliosis, foot deformities, hip deformities, pathologic fractures due to osteopaenia, etc.