Snapshot An infant is born in an refugee camp to a starving mother. He has a severe anatomic defect along the spinal tract. Introduction Birth defect in which the spinal canal, meninges, and backbone do not close before birth Most severe form of dysraphism involving the vertebral column Causes the spinal cord and meninges to protrude from the opening in the infants back Most common type of spina bifida Thought to be caused by low folic acid levels in the mother's diet Epidemiology incidence of 1/800 in the United States Presentation Symptoms may show partial paralysis sensory deficits loss of bladder or bowel control motor weakness Physical exam protruding spinal cord and meninges from the back club foot may be noted hydrocephalus sacral dimpling Evaluation Diagnosis based primarily on clinical observation Prenatal screening monitor folic acid levels in mother Pregnancy ultrasound may show herniated sac and incomplete spinal closure Amniocentesis Differential Other spina bifida and neural tube defects Treatment Medical management folic acid supplementation for mother prophylactic antibiotics may be indicated for prevention of meningitis and urinary tract infections Surgical intervention surgical repair of the defect indicated in all cases to prevent further herniation ventricular peritoneal shunt may be indicated in patients with hydrocephalus therpeutic abortion may be indicated or preferred in severe cases Prognosis, Prevention, and Complications Prognosis can usually be surgically corrected length of life is usually not affected with proper treatment paralysis is most often irreversible Prevention prenatal vitamins (specifically, folic acid) prevents development of neural tube disorders Complications scoliosis, foot or ankle deformities, dislocated hips, joint tightness or contractures, permanent present and further future spinal cord paralysis (with rapid pubescent growth period), frequent urinary tract infections, meningitis