Department of Neurosurgery

Spina bifida

Spina bifida means a developmental disorder of the spine and the spinal cord. There are different forms with accordingly various neurological deficits.

Spina bifida occulta

In case of Spina bifida occulta (occult or closed malformation/dysraphism) which is a gap in the vertebrae and covered by soft tissue, the processus spinosus of one or several lumbar vertebrae are missing. The covering skin is intact.

The neurological examination results are normal at first. But discoloration of the skin, abnormal hair growth, skin appendices, fat pads, or a retraction/stricture of skin draw attention on the hidden spinal deformities.

It might be a tumour such as an epidermoid or a dermoid. Also a lipoma (benign fat lump) or a diastematomyelia (split spinal cord) may occur. In some cases it is simply the fatty thickened end of the string of the spinal cord (filum terminale).

Spina bifida aperta

Spina bifida aperta, (the so-called open spine/back), is the most common form of defects of the neural tube and develops between the 21^st and 28^th day of pregnancy. It is most probably caused by different factors. With a prophylaxis of folic acid (prior to conception!) and through improved prenatal diagnosics, the number of newly diagnosed children at the time of birth is falling.

The incomplete closing of the embryonic spinal column/neural tube, the so-called dysraphism, is identifiable by a mass located in the dorsal midline. This mass is covered with skin (meningocele) or with a membrane (myelomeningocele). It contains liquor and meninges in case of a meningocele and the undeveloped neural plate (thickened plate of ectoderm from which the neural tube develops) in case of a myelomeningocele.

The neurological deficits are dependent on the location and extension of the defect and are irreversible. In most cases, spina bifida aperta occurs along with other defects such as hydrocephalus, Chiari malformation, syringomyelia, and tethered cord syndrome. Besides these neurological deformities, further defects in the orthopaedic field may occur, such as high arches, hip luxations, scoliosis and kyphosis. Furthermore, in the field of general surgery with inguinal hernia and in the urological sector with urinary bladder disorders, defects may occur.