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Monday, February 02, 2009

Spina Bifida

  • What is Spina bifida?

  • Spina bifida is a birth defect in central nervous system. It occurs as a result from neural tube failure to close during embryonic development. The term spina bifida comes from Latin and literally means "split" or "open" spine.

    Spina bifida commonly occurs at the end of the first month of pregnancy when the two sides of the embryo's spine fail to join together, leaving an open area. In some cases, the spinal cord or other membranes may push through this opening in the back. The condition usually is detected before a baby is born and treated right away.


    Type of Spina Bifida :

    1. Spina Bifida Occulta :
    Posterior vertebral arches fail to close in the lumbosacral area. Spinal cord remains intact and usually is not visible. Meninges are not exposed on the skin surface and neurological deficit are not usually present. In other word, Most children with this type of defect never have any health problems, and the spinal cord is often unaffected.

    2. Spina Bifida Cystica/Manifesta:
    The vertebra and neural tube close incomplete resulting in a saclike protrusion in the lumbar or sacral area. The defect includes meningocele, myelomeningocele, lipomeningocel, and lipomeningomyelocele.

  • Spina Bifida Cystica - Meningocele

  • The protrusion involves meninges and a saclike cyst that contains CSF in the midline of the back. Spinal cord is not involved and neurological deficits are usually not present.

  • Spina Bifida Cystica - Myelomeningocel

  • The protrusion involves meninges, CSF, nerve roots, and spinal cord. The sac is covered by a thin membrane that is prone to leakage or rupture. Neurological deficit are evident.


    Signs and Symptoms of Spina Bifida :

    Those patients were diagnosed as Spina Bifida, mostly they have sign and symptom bellow :
    • Visible spinal defect
    • Flaccid paralysis of the legs
    • Hip and joint deformities
    • Altered bladder and bowel function
    • Specific signs and symptoms depend on the spinal cord involvement

    Nursing Intervention of Spina Bifida :
    • Assess the sac and measure the lesion
    • Assess neurological system
    • Assess and monitor for increasing ICP
    • Measure head circumferences
    • Protect the sac, cover with a sterile, moist (normal saline), nonadherent dressing and change the dressing every 2-4 hours
    • Place patient in prone position and head to one side
    • Use antiseptic technique
    • Assess and monitor the sac for redness, clear or purulent drainage, abrasions, irritation, and signs of infection
    • Assess for hip and joint deformities
    • Administer medication: antibiotics, anticholinergics, and laxatives as prescribed

    Treatment of Spina Bifida :

    Currently, there is no cure for spina bifida, but there are a number of treatments available to help manage the disease and prevent complications. Initial goals of treatment include reducing neurological damage to your child, minimizing complications such as infections and helping your family learn about and cope with the disorder.

    Children with the mildest form of the disease, spina bifida occulta, usually do not require treatment (and often not for meningocele.). The key priorities in the treatment of myelomeningocele are to prevent infection from developing through the exposed nerves and tissue of the defect on the spine and to protect the exposed nerves and structures from additional trauma.

    Treatment of the severe form of spina bifida myelomeningocele depends on the specific problems caused by the spinal defect and may include surgery, physical therapy, and the use of braces and other aids.

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