Medical Management Considerations
Spina bifida is a neural tube defect resulting from the failure of the spine to close properly during the first month of pregnancy. It is the most frequently occurring permanently disabling birth defect. Although its cause is unknown, an influencing factor appears to be low maternal folic acid level before conception or during the first few weeks of pregnancy.
Spina Bifida Occulta: There is an opening in one or more of the vertebrae with no apparent damage to the spinal cord.
Meningocele: The meninges pushes out through an opening in the vertebrae in a sac, but the spinal cord remains intact. This form can be repaired with little or no damage to nerve pathways.
Myelomeningocele: A portion of the spinal cord protrudes through the back, causing severe damage to the spinal cord and nerve pathways.
The remainder of this document addresses this type of spina bifida, myelomeningocele.
Note: These considerations are in addition to the normal medical care provided to an individual without Spina Bifida. All recommendations can be addressed through clinical examination by the primary care provider, unless otherwise noted. As a preventive measure, the U.S. Public Health Services advises all women of childbearing age to consume 0.4 mg of folic acid daily.
Consider the following techniques and equipment as necessary*
*Note: Most of these require referral to a specialist.
Hoeman, S.P. (1997). Primary Care for Children with Spina Bifida. Nurse Practitioner 22(9), 60-62.
Klein, N.W. et al. (1996). Folic Acid and Prevention of Spina Bifida. Journal of the American Medical Association, 275(21), 1636.
Oi, S. et al. (1996). Neurological and Medico-Social Problems of Spina Bifida Patients in Adolescence and Adulthood. Childs Nervous System, 12(4), 181-187.
Wills, K.E. (1993). Neuropsychological Functioning in Children with Spina Bifida and/or Hydrocephalus. Journal of Clinical Child Psychology 22(2), 247-265.
Liptak, G. (1996). Neural Tube Defects. In Children with Disabilities (Fourth Edition). In ML Batshaw (Ed.), Children with Disabilities (4th ed., pp. 529-552). Baltimore: Paul H. Brookes.
Dorval, J. (1994). Achieving and Maintaining Body Systems Integrity and Function: Clinical Issues. Crystal City, Virginia: Centers for Disease Control and Prevention, Spina Bifida Association of America, United Cerebral Palsy Associations, Inc. and Shepherd Spinal Center.
National Information Center for Children and Youth with Disabilities. (1998). Spina Bifida Fact Sheet. Retrieved on May 1, 2006 from http://www.nichcy.org/pubs/factshe/fs12txt.htm
Smith Consultant Group and McGowan Consultants. (1998). Ed: Michele Ligon Snyder, MS. Shunted Hydrocephalus. Health and Wellness Reference Guide. Neri Productions, State of Tennessee Commission on Compliance, 231-233.
Smith Consultant Group and McGowan Consultants. 1998. Ed: Michele Ligon Snyder, MS. Spina Bifida. Health and Wellness Reference Guide. Neri Productions, State of Tennessee Commission on Compliance, 235-238.
Spina Bifida Association of America. (1997). Facts about Spina Bifida. Retrieved on May 1, 2006 from http://www.sbaa.org/site/PageServer?pagename=ASB_faq
California Department of Developmental Services, 916-654-1690,
California Regional Centers, 916-654-1958,
Children with Spina Bifida,
Guardians of Hydrocephalus Research Foundation, 800-458-8655
Hydrocephalus Association, 415-776-4713
International Federation for Hydrocephalus and Spina Bifida,
March of Dimes Birth Defects Foundation, 914-428-7100,
National Hydrocephalus Foundation, 815-467-6548
Spina Bifida Association of America, 800-621-3141,
Theodore A. Kastner, M.D., M.S.
Felice Weber Parisi, M.D., M.P.H.
Romie H. Holland, M.D.
Funded by a grant from the California Department of Developmental Services
For more information, contact:
Center for Health Improvement
1330 21st Street, Suite 100
Sacramento, CA 95814
This document does not provide advice regarding medical diagnosis or treatment for any individual case, and any opinions or statements contained in this document are not intended to serve as a standard of medical care. Physicians are encouraged to view the considerations presented in this document in light of evolving scientific information. This document is not intended for use by the layperson. Reproduction of this document may be done with proper credit given to California Department of Developmental Services and the Center for Health Improvement.