Spina Bifida Will Hinckle (Still only 1/3 of a Paramedic) Will Hinckle (Still only 1/3 of a Paramedic)

Basic Information  Spina Bifida (SB) is Latin for “Split Spine”  SB is the most common permanently disabling birth defect in the U.S. (Spina Bifida Association of Amerca)  SB is caused by a neural tube defect which results in incomplete formation of the spine and spinal cord canal  There are three types of SB: Occulta, Meningocele, and Myelomeningocele  Spina Bifida (SB) is Latin for “Split Spine”  SB is the most common permanently disabling birth defect in the U.S. (Spina Bifida Association of Amerca)  SB is caused by a neural tube defect which results in incomplete formation of the spine and spinal cord canal  There are three types of SB: Occulta, Meningocele, and Myelomeningocele

Embryonic Development  Closure of the neural tube normally occurs at 28 days after fertilization (Lissauer & Clayden)  This is almost always before the mother knows that she is pregnant  Closure of the neural tube normally occurs at 28 days after fertilization (Lissauer & Clayden)  This is almost always before the mother knows that she is pregnant

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Types of SB  Occulta: Least severe. Opening in the vertebrae is too small for cord to protrude (ASBAH). Many patients do not realize that they have it.

 Meningocele. The least common form is a posterior meningocele. The meninges form a fluid filled sac that protrudes through the opening in the vertebrae but the spinal cord and nerves are not involved. In an anterior meningocele, the sac enters the retroperitoneal space.

 Cystica (AKA myelomeningocele) is the most severe and most common type of SB (NIH). In this form, the meninges AND spinal cord protrude through the unfused vertebrae. The herniation can be repaired but there is usually permanent nerve damage. Control of lower extremities is affected as well as bowel and bladder control.

Causes of SB  Anticonvulsant medications  Diabetes  Having a relative with SB  Obesity  Increased body temperature from fever or external sources such as hot tubs, warming blankets etc.  Studies of mouse strains with SB suggest a genetic link  HOWEVER, most of the women who deliver babies with SB have none of the above risk factors and an actual cause is not known  Anticonvulsant medications  Diabetes  Having a relative with SB  Obesity  Increased body temperature from fever or external sources such as hot tubs, warming blankets etc.  Studies of mouse strains with SB suggest a genetic link  HOWEVER, most of the women who deliver babies with SB have none of the above risk factors and an actual cause is not known

Incidence of SB (Lamire, Colton) .7 per 1000 live births in U.S.  Higher on East coast than West  Higher in whites (1/1000) than blacks (.1-.4/1000)  Higher in females than males .7 per 1000 live births in U.S.  Higher on East coast than West  Higher in whites (1/1000) than blacks (.1-.4/1000)  Higher in females than males

Interesting Facts  Over 73% of people with SB develop an allergy to latex products (SBAA)  Daily Folic acid supplements taken prior to conception can reduce the risk of SB by up to 70% (ASBAH)  Surgeons are now attempting to repair SB defects prior to birth  Hank Williams Sr. and John Mellencamp both have SB occulta (Wikipedia)  Over 73% of people with SB develop an allergy to latex products (SBAA)  Daily Folic acid supplements taken prior to conception can reduce the risk of SB by up to 70% (ASBAH)  Surgeons are now attempting to repair SB defects prior to birth  Hank Williams Sr. and John Mellencamp both have SB occulta (Wikipedia)

Conflicting Information  Incidence is higher in the South (SBAA) Or  Incidence in higher on the East coast (Lemire)  Incidence is higher in the South (SBAA) Or  Incidence in higher on the East coast (Lemire)

Sources T. Lissauer, G. Clayden. Illustrated Textbook of Paediatrics (Second Edition). Mosby, 2003 Lemire RJ (1988). "Neural tube defects". JAMA 259 (4): 558–62 Cotton P (1993). "Finding neural tube 'zippers' may let geneticists tailor prevention of defects". JAMA 270 (14): 1663–4 “Myelominingocele”. NIH. Retrieved on "Spina Bifida Occulta". ASBAH. Retrieved on “Spina Bifida’. Wikipedia. Retrieved on Spinabifidaassociation.org. Retrieved on T. Lissauer, G. Clayden. Illustrated Textbook of Paediatrics (Second Edition). Mosby, 2003 Lemire RJ (1988). "Neural tube defects". JAMA 259 (4): 558–62 Cotton P (1993). "Finding neural tube 'zippers' may let geneticists tailor prevention of defects". JAMA 270 (14): 1663–4 “Myelominingocele”. NIH. Retrieved on "Spina Bifida Occulta". ASBAH. Retrieved on “Spina Bifida’. Wikipedia. Retrieved on Spinabifidaassociation.org. Retrieved on