bubble_chart Overview

Spina bifida refers to a congenital malformation caused by incomplete closure of the spinal canal, resulting in an opening on the dorsal or ventral side of the spine, which may or may not be accompanied by protrusion of the spinal membrane or neural components. It can be classified into two types: spina bifida occulta and spina bifida manifesta. The former involves only the absence of the vertebral lamina, while the latter, in addition to the absence of the vertebral lamina, includes protrusion of the spinal membrane or the spinal membrane along with the spinal cord, further divided into meningocele and myelomeningocele. The main clinical manifestations include a protruding mass in the lumbar or lumbosacral region and neurological dysfunction. The incidence of this condition shows no regional or gender differences, and the primary treatment is surgical. The prognosis is best for simple meningocele, whereas myelomeningocele has a poor prognosis and a high mortality rate.

bubble_chart Clinical Manifestations

1. Occult spina bifida often shows no local signs or neurological impairment symptoms and is usually discovered incidentally during lumbosacral X-rays taken for other reasons. A few children may have a small skin dimple, a tuft of hair, a patch of hemangioma, pigmentation, a raised lipoma, or associated conditions such as enuresis, clubfoot, or scoliosis.
2. Meningocele:
   1. A cystic protrusion is commonly observed in the midline of the lumbosacral region, with a relatively narrow base and a fluctuant sensation. It may enlarge or increase in tension with elevated intracranial pressure and appears uniformly translucent.
   2. The surface of the protrusion may be covered by normal skin or a membrane-like tissue.
   3. No neurological impairment symptoms are present.
3. Myelomeningocele:
   1. A protrusion is often seen in the midline of the lumbar or lumbosacral region, with a broader base. The surface may be covered by normal skin or a membrane-like dermal layer.
   2. Spinal cord dysfunction manifests as complete or incomplete flaccid paralysis and sensory loss in one or both lower limbs, urinary incontinence (e.g., persistently wet diapers), and clubfoot.
   3. Hydrocephalus may coexist.
4. Myeloschisis or myelocystocele: After birth, the infant is found to have exposed spinal cord tissue at the affected site, resembling red granulation tissue. Without dorsal membrane or skin coverage, cerebrospinal fluid continuously leaks, making the infant highly susceptible to meningitis and often unlikely to survive.

bubble_chart Diagnosis

1. After birth, a localized cystic mass can be seen in the midline of the back in infants, varying in size.
2. Dysfunction of the lower limbs, urinary incontinence, or the presence of clubfoot may be observed.
3. Transillumination test of the mass: If the contents are cerebrospinal fluid, it will show uniform translucency; if it contains spinal cord or fat, it will not be translucent.
4. Spinal X-ray reveals defects in the vertebral lamina.
5. Computed tomography or magnetic resonance imaging of the corresponding mass area shows that the mass communicates with the spinal canal through a fissure, which may contain cerebrospinal fluid or spinal nerves.

bubble_chart Treatment Measures

1. Surgical treatment: For cases where the protruding mass is not covered by skin, surgical repair should be performed immediately after birth or within 1–2 days to prevent meningitis. For other cases, surgery is preferable within 1–3 months after birth.
2. Prevent infection and provide symptomatic treatment.

This condition is a common malformation resulting from incomplete neural tube closure during the embryonic stage of the fetus. The disease cause may be related to the susceptibility of the central nervous system during development to factors such as trauma, infection, radiation exposure, or chemical damage. Pregnant women should avoid exposure to these factors during early pregnancy. If a protruding mass is found in the lumbosacral region of a newborn, avoid using folk remedies like plaster for swelling reduction, as this may lead to rupture and infection of the mass. Instead, seek medical treatment under a doctor's guidance. Post-surgery, the child should avoid excessive crying to prevent rupture of the repaired spinal membrane and re-protrusion of spinal canal contents. Additionally, the child should be placed in a prone position with the buttocks slightly elevated to prevent wound contamination by urine or feces.

bubble_chart Cure Criteria

1. Cure: The protruding mass disappears, and limb movement, sensation, and urinary and bowel functions significantly recover.
2. Improvement: The protruding mass shrinks, and neurological symptoms slightly improve.
3. No cure: The protrusion reappears, and neurological symptoms show no improvement.