65. Closure abnormalities of the spinal cord

From greek.doctor
  • 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.