Spina Bifida (cont.)
Spina Bifida Symptoms
Meningocele and myelomeningocele are evident at birth. Other than the obvious spinal cord deformity, symptoms are caused by complications of spina bifida. The most common complications include the following:
- People with spina bifida occulta are almost always completely asymptomatic.
- Even after one or more operations to correct the defects, some disability almost always remains. Various degrees of leg paralysis, spine curvature (scoliosis), hip, foot, and leg deformities, and problems with bowel and bladder control are the most common residual disabilities.
- Abnormalities at the lower spine are always accompanied by upper spine abnormalities (Arnold-Chiari malformation), causing subtle coordination problems that usually can be improved by physical therapy.
- Spine, hip, foot, and leg deformities are often due to imbalances in muscle strength and function resulting mostly from residual paralysis, but with a spasticity component.
- The most common bladder and bowel problems are inability to voluntarily relax the muscles (sphincters) that hold urine in the bladder and stool in the rectum.
- Hydrocephalus (accumulation of fluid in the brain) is another common residual problem, affecting about 90% of people with spina bifida. Having some fluid around the brain is normal and healthy, but in spina bifida the fluid often cannot drain naturally. Without treatment, this extra fluid can cause neurological problems or mental retardation; however, these individuals are of normal intelligence if their hydrocephalus is treated aggressively. Hydrocephalus often recurs gradually after treatment.
- Many children with myelomeningocele have or develop a tethered spinal cord. The cord is attached to surrounding tissues and cannot move up and down freely as it normally does. This can cause foot or leg deformities, hip dislocation, or scoliosis. The problems can worsen as the child grows and the tethered cord is stretched.
- Obesity (due to inactivity) and urinary tract disorders (due to poor drainage) are common complications of spina bifida.
- Pathologic bone fractures occur in as many as 25% of people with spina bifida. A pathologic fracture is a break that occurs because of weakness or disease in the bones, not solely because of injury. A very minor injury can worsen a pathologic fracture, causing pain and bringing the fracture to medical attention.
- Growth hormone deficiency resulting in short stature is common in people with spina bifida. On average they are several inches shorter than siblings or peers.
- Although most people with spina bifida have normal intelligence, many have learning disorders. Adequate treatment of hydrocephalus and adaptive physical therapy are necessary to permit access to educational opportunities.
- Psychological, social, and sexual problems occur more often in people with spina bifida than in the general population.
- Allergy to latex (a natural rubber used in medical gloves, some types of elastic, balloons, and many other common items) is very common in people with spina bifida. This is thought to be a result of intense exposure to latex in the early years of life because of frequent surgeries and other medical procedures. An allergic reaction to latex can be life threatening.
Even individuals with no apparent symptoms or disability from spina bifida may have subtle or mild signs or neurological problems. Some, for example, have a dimple, darkening, or small hairy patch on the skin overlying the base of the spine. Others have a fatty growth called an epidural lipoma that forms within the spinal canal; this is usually harmless but may result in tethering of the spinal cord.
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