Spina Bifida is a type of Neural tube defects which are congenital anomalies of neural development with a spectrum of clinical manifestations; they can affect the cranium or spine.
Open spinal dysraphism (spina bifida aperta) is characterized by a cleft in the spinal column, with herniation of the meninges (meningocele) or meninges and spinal cord (myelomeningocele) through the defect.
Spina bifida occulta or Closed spinal dysraphism is characterized by failure of fusion of the vertebral bodies due to abnormal fusion of the posterior vertebral arches, with unexposed neural tissue; the skin overlying the defect is intact. The more common and least severe forms consist of isolated vertebral bony defects. However, the vertebral defects may occur in association with other more severe anomalies of the spinal cord and sacral structures, such as split spinal cord malformation or various cavitary defects of the spinal cord.
Surgery is considered the mainstay of treatment for closed spinal dysraphism (CSD). Patients with impairments due to neurologic deficits, bladder dysfunction, or chronic pain may benefit from physical and occupational therapy . Surveillance and monitoring is needed to detect new or progressive deficits.
Some affected individuals remain asymptomatic into adulthood, at which time they may develop back pain with or without radiculopathy and perineal dysesthesias.
Pain related to CSD usually is reported in the lower back, sacrococcygeal or gluteal areas, with or without a radicular pattern. Pain may be exacerbated with Valsalva maneuver in the cases of lesions that are in communication with the subarachnoid space, such as Tarlov cysts.
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