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Spina bifida means split or open spinal cord. It is a name given to the defective development of any part of the spinal cord. As the baby's spine develops in the womb, one or more vertebrae and a part of the spinal cord cannot develop well, with varying degrees of disease in the spinal cord and nervous system. Because the nerves to the legs, urinary bladder and large intestines do not work, a partial paralysis is seen for a lifetime. Spina bifida occurs in the first month of pregnancy when the mother is not yet aware of the pregnancy. This problem is also called congenital anomaly because it occurs in the mother's womb. After the second month of pregnancy, the presence of spina bifida in the baby can be detected by ultrasound examination. In our country, between three and five thousand spine bifida babies whose spine and spine are not well developed are born every year. In risky families, that is, mothers who have given birth to babies with spina bifida or those with spina bifida in their families, sarhim fluid can be taken and examined. In addition, it is known that the use of folic acid (folbiol) vitamin for a period of time decreases the possibility of spina bifida in the baby, provided that each expectant mother begins to get pregnant. If spina bifida is detected in the first months of pregnancy by ultrasound, pregnancy can be terminated with the consent of the family (medical abortion). If spina bifida is detected in the last months of pregnancy or if the family does not want an abortion, the baby is delivered by cesarean section to prevent damage to the sac and increase the paralysis. There is still no answer to the question of why spina bifida causes, but studies are ongoing. One of the reasons that may cause spina bifidia is that the mother does not get enough folic acid (folbiol) during pregnancy. Sometimes spina bifida is more common in some families for genetic reasons. In addition, the mother's use of valproic acid (depakin) can cause spina bifida.
There are two main types of spina bifida;
1. Spina bifida in the oculus (closed-secret)
In some cases, this minor failure of the spine causes the spine to compress and stretch. This is also called tethered cord syndrome. Stretching of the spinal cord disrupts the functioning of the nervous system. In these cases, weakness in leg movements and incontinence can be seen.
2. Spina bifida cystica (marsupial spina bifida)
A sac or cyst is observed on the back covered with a thin layer of skin. There are two types;
a) Meningocele; In this type of sac there are tissues surrounding the spinal cord and spinal fluid. Spinal fluid washes and protects the spinal cord and brain. In this case, as the nerves are not damaged much, there is very little disability. This is the most rare form.
b) Mylomeningocele; This is more common and more serious. There are not only spinal fluid, but also spinal cord parts and nerves. The spinal cord is damaged or underdeveloped. As a result, there is always a partial paralysis and loss of sensation under the damaged vertebrae. The degree of disability depends on the location of the spina bifida and the amount of nerve affected. Most children also have bladder and bowel problems.
All pregnant women are at risk of having children with spina bifida. It is very difficult to predict which woman's baby will be affected. However, some known risk factors are; Previously affected women with spina bifida, mother or father's family with spina bifida, diabetes, epilepsy treatment, overweight, over 35 years of birth, women exposed to extreme heat in the early stages of pregnancy, socio-economic status of women The risk of giving birth to a baby with spina bifida is greater. There are evidence that spina bifida increases after natural disasters, such as severe economic crises, earthquakes, floods, and wars.
Spina bifida patients are not sick. But some organs of the body may have problems. It is most affected by the nervous system (brain and spinal cord), urinary tract (kidney and bladder), intestines and musculoskeletal system. If the circulation of the spinal fluid feeding the brain and spinal cord is impaired as a result of spina bifida, hydrocephalus (fluid accumulation in the brain) develops. When the cerebrospinal fluid, which protects and nourishes the brain, cannot flow freely, it accumulates and builds up pressure in the brain and may disrupt the development of the brain. This problem can be solved by installing a hose called a shunt inside the brain. 80-90% of children with spina bifida develop hydrocephalus. The shunt carries the spinal fluid from the brain to the abdominal cavity. From there, the liquid enters the blood. This tube, which is not seen from the outside, is not attached to anyone with spina bifida and hydrocephalus, but may be required in most cases.
When the baby with spina bifida is born, a small surgery is performed to close the sac. After this operation, repair tissue is formed at the operation site. This repair tissue may adhere to the spinal cord or surrounding bone. As a result of this adhesion, the spinal cord is stretched over time. This is usually observed in the growing age.
Symptoms of “stretched spinal cord;;
- Scoliosis (spine bending)
- Abduction of urine or large ablutions
- Difficulty walking
- Deformity or numbness of the feet
An operation is required to loosen the stretched spinal cord. Everyone born with spina bifida has a risk of stretching the spinal cord, but only some have problems requiring surgery. Some babies born with spina bifida have a problem known as Chiari. This event in the brain is named after the scientist who discovered it. Chiari means that the lower part of the brain shifts into the spinal canal. Therefore, hydrocephalus is developing. Many people do not have a problem with the shari when wearing the shunt. Most people with spina bifida have bladder problems. Some of the nerves that control the bladder were injured before the baby was born. There are two types of problems in the bladder due to spina bifida. Either the person cannot empty all urine in the bladder and the urine remains in the bladder, or it cannot hold the bladder and the urine flows out continuously. If urine accumulated in the bladder escapes back to the kidneys, the kidney may deteriorate over time.
Prepared; Erdi KANBAŞ-Special Education Specialist, For all your suggestions, comments and questions; email: [email protected]
- Ankara Spina Bifida Association, What is Spina Bifida ?, www.spinabifida.dernegi.com
- Spina Bifida Association, What is Spina Bifida ?, www.spinabifida.org.tr