Split spine is professionally known as “spina bifida”. It is a relatively common congenital defect, which has several forms with different seriousness. Some types are virtually harmless, but the others represent a great cosmetic defect and threaten the patient with many complications.
Split spine is a congenital defect of closure of the neural tube. It is not entirely clear, why this disorder happens, but lack of folic acid during pregnancy is assumed to have a big importance. In addition, spina bifida was more frequently observed in children of obese mothers and mothers with type 2 diabetes.
Generally, spina bifida occurs at the back in the lumbar area. According to the severity of the defect, we distinguish spina bifida occulta, meningocele and myelomeningocele.
Spina bifida occulta
This is the most common type of split spine. Back parts of the vertebrae are missing in the affected location, but the spinal cord is normally in its proper place and the skin cover is solid and intact. Sometimes, the skin above the split spine is more hairy, pigmented or the skin to grow hair more noticeable, sometimes there is a pigmented stain or dented. There are usually no neurological symptoms.
The defect is more serious as the spinal meninges (layers covering the spine) are protruding out of the spinal canal, but the spine itself is stored correctly within the spinal canal. However, this type of split spine is very rare.
This is the most severe form of spina bifida. The back parts of vertebrae are missing and the spine protrudes outside the spinal canal covered by the meninges. The protruding bag-like structure is covered by only a thin skin layer and the most severe cases have no skin cover at all.
The symptoms depend on the severity of the defect and the extent of involved spinal cord. Mild forms have practically no manifestation, while the severe forms may cause many neurological symptoms including disorders of sensitivity and mobility of the lower extremities and sphincter disorders (urinary incontinence, fecal incontinence). People with myelomeningocele often suffer from different deformations of the brain causing disruption of flow of the cerebrospinal fluid, which may result in hydrocephalus, epilepsy and mental retardation. Relatively many people with spina bifida suffer from allergy to latex, but the reason is not clear.
Increased intake of folic acid is recommended in pregnant women (preferably in food or as a dietary supplement).
Heavier forms of spina bifida are apparent at first sight. During pregnancy, the split spine may be found in the fetus by an ultrasound. After the birth, myelomeningocele is visible at the back in the lumbar area as a bag containing the spinal cord, which is either covered by skin, or the nerve tissue is directly on the surface. The evaluation of local anatomy and the extent of the defect are possible by imaging methods such as the X-ray, computed tomography or magnetic resonance imaging.
Modern medicine is able to minimize the cosmetic defect, close the hole surgically and return the spinal cord with the meninges back into the spinal canal. The treatment also protects the patient from any infectious complications of the central nervous system. However, once there is present a damage of the spine with neurological symptoms, not too much can be done. When the patient suffers from hydrocephalus, various surgical interventions are performed to ensure the drainage of the cerebrospinal fluid and to prevent its further accumulation.