Three Main Classifications Of Spina Bifida (Mclone, 2016a)

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Spina Bifida
Maya Bastian
University of Minnesota
Spina Bifida
Introduction
Spina bifida is a spinal cord malformation caused by a defect of the neural tube (McLone, & Bowman, 2016a). There are three main classifications of spina bifida (McLone, & Bowman, 2016a). Myelomeningocele, the most serious neural tube defect, is visible at birth. Children with myelomeningocele have a cleft in the vertebral column, with a corresponding defect in the skin resulting in a sac of fluid that contains exposed meninges and spinal cord (McLone, & Bowman, 2016a). This leads to malformation of the vertebral column and spinal cord, and ultimately the skull and brain. Therefore myelominingocele can cause numerous impairments such as lower limb paralysis,
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Folic acid deficiency has been identified as a risk factor for the development of neural tube defects (McLone, & Bowman, 2016a). Certain medications such as valproate or folic acid antagonists also increase risk (McLone, & Bowman, 2016a). Prenatal diagnosis can be done by maternal screening of serum alpha fetoprotein (AFP) levels between 15-20 weeks gestation (McLone, & Bowman, 2016a). Diagnosis is confirmed with ultrasound. Before the 12th week it is possible to see irregularities of the bony spine or a bulging at the fetal back. After the 12th week, it is possible to detect the lemon sign and the banana sign. The lemon sign is an indentation of the frontal bone. The banana sign refers to a banana shaped cerebellum due to a shallow posterior fossa (McLone, & Bowman, 2016a). Other findings that indicate spina bifida are ventriculomegaly, microcephaly, and effacement of the cisterna magnum ( McLone, & Bowman, 2016a) Myelomeningoceles are usually obvious at birth, even if undetected in …show more content…
Three main areas of concern associated with spina bifida are the spinal cord, the brainstem, and hydrocephalus. The location of the sac in part determines the types of deficits a child will have. Most patients will have complete paralysis and absence of sensation affecting the legs and trunk, although severity of motor and sensory loss is dependent on the level of lesion (McLone, & Bowman, 2016a). The bladder and bowel are affected in 97 percent of patients, resulting in urinary and fecal incontinence (McLone, & Bowman, 2016a) The majority of children with spina bifida will have spinal and lower extremity deformities as well as joint contractures (Foster, 2016). Several other spinal deformities may occur such as lordosis, scoliosis, rib abnormalities, and kyphosis are possible (Foster, 2016). The higher the positioning of the meningocele, the more likely the child is to have spinal deformities (Foster, 2016). Most patients with myelomeningocele also have brainstem dysfunction because they have brain tissue descending down into the spinal cord. This is known as a Chiari malformation (Foster, 2016). Chiari malformation can causes problems such as swallowing difficulties, breathing problems, weakness in the arms, strabismus and facial weakness (Foster,

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