During the first month of life, an embryo (developing baby) grows a structure called the neural tube that will eventually form the spine and nervous system.
In cases of spina bifida, something goes wrong and the spinal column (the bone that surrounds and protects the nerves) does not fully close. Spina bifida is also known as split spine.
The exact reasons why this happens are unknown but several risk factors have been identified, the most significant being a lack of folic acid before and at the very start of pregnancy.
The most effective way to prevent spina bifida (myelomeningocele) is to take folic acid supplements both before and during pregnancy.
Folic acid
The Department of Health recommends all women who might get pregnant should take a daily supplement of 0.4mg of folic acid. You should also take this supplement for the first 12 weeks of pregnancy because this is when your baby's spine is developing.
Women thought to be at higher risk of having a child with spina bifida may need a higher dose of folic acid. This includes women who:
• have diabetes, a condition caused by too much glucose (sugar) in the blood
• are taking medicines, such as carbamazepine, used to treat epilepsy, a condition that causes repeated seizures (fits)
Your GP will advise you about this.
Folic acid tablets are available on prescription or from pharmacies, large supermarkets and health food stores. Natural sources of folic acid include:
• broccoli
• peas
• asparagus
• brussels sprouts
• chickpeas
• brown rice
• some bread
• some breakfast cereals
If you are taking medication for a condition such as epilepsy, it is important you check with your GP before taking folic acid. This is because some types of medication can cancel out the effects of folic acid supplements.
Myelomeningocele – one in one thousand pregnancies
There are a number of different types of spina bifida, the most serious being myelomeningocele (affecting one pregnancy in every 1,000 in Britain).
These pages focus on myelomeningocele and this is the type of spina bifida referred to whenever the term spina bifida is used.
In myelomeningocele, the spinal column remains open along the bones that make up the spine. The membranes and spinal cord push out to create a sac in the baby’s back. This sometimes leaves the nervous system vulnerable to infections that may be fatal.
In most cases of myelomeningocele, surgery can be carried out to close the defect. However, damage to the nervous system will usually have already taken place, resulting in a range of symptoms including:
• partial or total paralysis of the lower limbs
• bowel incontinence and urinary incontinence
• loss of skin sensation
Read more about the symptoms of spina bifida.
Most babies with myelomeningocele will also develop hydrocephalus, which is excess cerebrospinal fluid (CSF) surrounding the brain.
Hydrocephalus needs to be treated urgently with surgery as the pressure on the brain can cause brain damage.
Read more about hydrocephalus.
Different types of spina bifida
Spina bifida occulta
Spina bifida occulta is the least serious type of spina bifida. In this type of spina bifida, the opening in the spine is very small, with a gap in one or more vertebrae (disc-shaped bones of the spine). The opening in the spine is covered with skin, so the gap is not visible from the outside.
Spina bifida occulta does not usually cause any symptoms and most people are unaware they have the condition. In such cases, no treatment is required. In other cases, some symptoms may be apparent, such as bladder and bowel problems, or scoliosis (an abnormal curvature of the spine).
Spina bifida meningocele
Spina bifida meningocele is the rarest type of spina bifida. In this type the protective membranes that surround the spinal cord (the meninges) are pushed out between openings in the vertebrae. The membranes can usually be removed during surgery and no further treatment is required.
In spina bifida meningocele, the nervous system is undamaged. However, it may lead to other problems, including bladder and bowel problems.
Treating spina bifida
A number of different treatments can be used to treat symptoms or conditions associated with spina bifida.
These can include:
• surgery on the spine - at birth to repair the spine and corrective surgery later in life if further problems develop
• surgery to treat hydrocephalus - for example, placing a shunt
• therapies to help improve day to day life and boost independence - such as physiotherapyand occupational therapy
• assistive technology - such as a manual or electric wheelchair or computer software to help with schoolwork and writing
• treatments for bowel and urinary problems
Read more about how spina bifida is treated andcomplications of spina bifida.
It is likely that children with spina bifida will survive well into adulthood. It can be a challenging condition to live with, but many adults with spina bifida are able to lead independent and fulfilling lives.
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