The cleft vertebra ( spina bifida ) is a very rare malformation of the child’s body in the womb. It comes in different forms, which are treated differently. Modern medicine is able to treat spina bifida in the unborn child.
What is a cleft vertebra?
The doctor describes an extremely rare spinal deformity as a cleft vertebra or an open back. It is congenital and in some cases even affects the spinal cord and its membranes. The cleft vertebra forms in the third to fourth week of pregnancy when the neural tube is formed. For mediastinitis explanations, please visit aviationopedia.com.
In the further course of embryonic development, the vertebral column, spinal cord and brain finally emerge from it. If the neural tube does not close completely, deformation of the vertebrae occurs at the relevant point: the spinal cord emerges through the vertebral arches that are not completely closed. The cleft vertebra is usually located at the lower end of the spine.
It comes in three forms. The hidden cleft vertebra (spina bifida occulta) causes little or no discomfort. Doctors call the dermal sinus an outwardly open channel between the spinal cord and the surface of the skin. In the case of an open cleft vertebra (spina bifida aperta), the meninges and spinal cord (myelon) or only the meninges are damaged.
The spinal cord emerges from the spinal canal like a sac. However, if the spinal cord is affected, a myelomeningocele is present. This form of open back is the most common. In myelocele, the spinal cord is not covered with skin. If the open back is recognized in good time and treated accordingly, the children usually develop normally both physically and mentally.
Causes
The exact causes of the cleft vertebra have not yet been clarified. Doctors assume that the combination of genetic predisposition and various external factors leads to the development of the malformation. Possible risk factors include a lack of folic acid during pregnancy and taking certain medications for epilepsy ( valproate ).
Medicine also blames nicotine and alcohol consumption as well as excessive exposure to radiation (X-rays). Since spina bifida is often associated with consequential damage, the affected children need medical care throughout their lives.
Symptoms, Ailments & Signs
Spina bifida occulta is sometimes associated with urinary retention and rapid fatigue in the legs. In the case of spina bifida aperta, on the other hand, there are no symptoms if the spinal cord is intact (meningocele). If this is not the case, however, the cerebrospinal fluid can no longer drain into the spinal cord canal and accumulates in the brain chambers (ventricles).
A hydrocephalus forms. The dermal sinus manifests itself in the form of frequently recurring meningeal infections, since the pathogens can enter the spinal cord via the open canal. Severe cleft vertebra deformities often occur in conjunction with paraplegia. The neurological deficits depend on how high the cleft vertebra is.
Many patients have leg paralysis due to muscle atrophy. Sometimes there are also sensory disturbances. Almost all child patients have a disturbed bowel and bladder emptying up to incontinence or stool and urinary retention. Some of them also have a foot deformity ( clubfoot ) or a hip misalignment.
Diagnosis & course of disease
Spina bifida can be diagnosed using a variety of prenatal diagnostic methods. The examining doctor measures the alpha-1-fetoprotein in the mother’s blood or amniotic fluid. If his concentration is increased, he can use it to confirm his spina bifida diagnosis. An ultrasound examination carried out between the 12th and 14th week of pregnancy makes an existing cleft vertebra formation visible.
Measurement of ventricle size and skull diameter can indicate hydrocephalus. However, the exact extent of the malformation can only be assessed with certainty after the pregnant woman has given birth. In the first days of the baby’s life, the doctor carries out a magnetic resonance imaging (MRT) or an ultrasound in order to be able to better assess the malformation and any pathological changes in the brain.
Complications
Typical complications of a cleft vertebra are inflammation of the membranes of the spinal cord, the spinal cord and the kidneys. A bladder infection is also not unlikely. Serious encephalitis can also occur. In the further course, adhesions and scarring in the area of the spinal cord can lead to neurological complaints.
Joint and spinal deformities can occur, such as scoliosis or clubfoot. If hydrocephalus (water on the head) is present, it must be treated urgently, as the ever-increasing pressure of the cerebrospinal fluid on the brain can cause serious damage. In treatment, the dangers emanate from surgical intervention.
Surgery can be associated with bleeding, postoperative bleeding, infection, and nerve injury. The latter often leads to sensory disturbances and other complaints. Wound healing disorders and temporary signs of paralysis can occur after the operation. In addition, scars sometimes form, which are also associated with sensory disturbances.
If a catheter is placed to drain excess brain fluid, this can lead to infections. Drug therapy is associated with side effects and interactions. Typical side effects are skin irritations, complaints of the gastrointestinal tract and pain in different parts of the body. Allergic reactions to the agents and materials used can also occur.
When should you go to the doctor?
A doctor should always be consulted if there is a cleft vertebra. This disease can only be completely cured by early and, above all, correct treatment by a doctor. As a rule, the sooner the doctor is consulted, the better the further course of this disease. A doctor should be consulted at the first sign of a cleft vertebra.
The doctor should be consulted if the person concerned has to go to the toilet very often and is permanently tired. The fatigue occurs all over the body, but it affects the legs the most. Infections from this disease can also occur more easily. Those affected also show sensory disturbances or incontinence. If these symptoms occur, a doctor must be consulted immediately, since in the worst case the cleft vertebra can lead to complete paralysis.
A malposition of the hips or feet can also indicate a cleft vertebra and should be examined by a doctor. In most cases, the disease can be diagnosed by a general practitioner. Further treatment is then carried out by a specialist.
Treatment & Therapy
The treatment of the cleft vertebra depends on the form of the deformation, how severe it is and whether there is any other damage. The dermal sinus must be closed using a neurosurgical procedure. The meningoceles are also treated surgically. Pregnant women who have been diagnosed with a myelomeningocele usually give birth by cesarean section.
The surgeon then closes the open back. Spina bifida operations are carried out in special clinics in the womb using laparoscopy (endoscopy) or an abdominal incision. Hydrocephalus is treated in the child’s first week of life by placing a shunt (special catheter) so that the excess brain fluid drains into the abdomen.
Disturbed bladder emptying can be treated with medication. Since the leg paralysis can cause a spinal curvature ( scoliosis ), the orthopedist uses orthoses and bandages and prescribes physiotherapy. Because the surgical correction of the cleft vertebra performed in early childhood leaves scars, the neurological symptoms worsen later as the child grows. More surgeries follow.
Prevention
To minimize the risk of giving birth to a child with an open spine, doctors advise affected women to take a folic acid supplement at least four weeks before a planned pregnancy and not stop taking it until the fourth month of pregnancy.
The patient learns from her doctor which remedy is most suitable. It is best for epilepsy patients who wish to have children to talk to their doctor in good time about the dosage of valproate during pregnancy. In addition, the expectant mother should completely abstain from alcohol and cigarettes.
Aftercare
A congenital misalignment of the vertebrae has a chronic character. The spinal cord is not surrounded by the vertebra at certain points, and the protection provided by the vertebral process is missing. Such split vertebrae must be treated at an early stage. If the diagnosis is made too late, those affected are often paraplegic.
There are also milder courses such as spina bifida occulta, which enable the patient to lead a normal life. They often do not cause any symptoms and are often recognized purely by chance. Follow-up care depends on the severity. Mild symptoms do not require close monitoring. Occasional check-ups with an orthopedist are usually sufficient in these cases.
In severe cases, lifelong follow-up care is a necessity. The malformed vertebrae require surgical intervention, and the subsequent symptoms must be treated by a doctor. Follow-up care is common after the operation. The doctor checks the healing process. Consequential damage should be avoided. The danger of a permanent curvature of the spine is high with improper aftercare.
After an expected healing, the specialist stops the follow-up care. Neurological deficits are caused by the damaged spinal cord. They are irrecoverable. Aftercare focuses on everyday handling of the paralysis. Pain can be relieved with appropriate medication.
You can do that yourself
A cleft vertebra does not cause problems or health impairments for every patient. If it is only slightly pronounced, the affected person often remains symptom-free for life. To avoid complications, it is necessary to avoid overloading the body. Physical exertion should therefore be avoided in everyday life. Even with the first inconvenience, sufficient rest and protection are important. Movement sequences should be discussed with a physiotherapist and optimized if possible. The training courses learned can be implemented independently at any time in everyday life. Being overweight should be avoided as it puts additional strain on the skeletal system.
In an advanced stage of the disease, those affected often complain of rapid exhaustion and easy fatigue. The signs of the organism must be taken into account in everyday events and appropriate breaks must be taken. Therefore, physical and sporting activities should be adapted to the body’s possibilities and the first signs of discomfort should be taken into account. Heavy professional work is to be completely avoided.
If the disease is severe, there are often additional signs of paralysis. This form of the disease poses a great challenge in coping with everyday life. Emotional stability and a stable social environment are important for this in order to be able to handle the adversities of the disease. Conditions of emotional stress should be clarified and resolved as early as possible.
