Spina bifida aperta (open spina bifida) refers to an area of opening on the back with an exposed spinal cord, the so-called myelomeningocele. A myelomeningocele occurs due to abnormal closure of the neural tube at the end of the first month of pregnancy, and occurs with other abnormalities of the nervous system including hydrocephalus and the Chiari II hindbrain malformation. The overall prognosis for children born with a myelomeningocele is good, and our expectation is that these children will lead healthy, fulfilling and productive lives. Nevertheless, the time when the diagnosis is made can be quite overwhelming. If the myelomeningocele is diagnosed prior to birth, prenatal counseling can ease the family's intellectual and emotional burden at the time of birth. Our experienced multidisciplinary spina bifida team supports families through the difficult time at birth and afterwards. Myelomeningoceles require repair within soon after birth to close the defect and limit the chance of life-threatening infection. The majority of infants require treatment of hydrocephalus. Pediatric specialists from neurosurgery, orthopaedics, neurology, urology, physical and occupational therapy and social service attend the Neuromuscular Clinic to ensure children and adults receive comprehensive care throughout their life.
Occult spina bifida (closed spina bifida) refers to skin-covered abnormalities of the spine and spinal cord, a distinct and different problem than open spina bifida. Occult lesions are meningoceles, lipomyelomeningoceles, and other lesions with cutaneous markers including abnormally pigmented areas, hair patches, lipomas, sinus tracts and dimples along the spine. These lesions can all cause progressive deterioration from a tethered spinal cord (tethered cord). If a tethered spinal cord is identified by imaging (usually MRI or ultrasound), it is repaired surgically by a straightforward surgical detethering procedure to prevent problems such as weakness, pain, bowel/bladder dysfunction, or orthopaedic problems such as foot deformities or scoliosis (curvature of the spine).