Myelomeningocele

Contents of this page:

• Treatment
• Illustrations
• Support Groups
• Alternative Names
• Outlook (Prognosis)
• Definition
• Possible Complications
• Causes
• When to Contact a Medical
• Symptoms
Professional
• Exams and Tests
• Prevention

Illustrations

Spina bifida Spina bifida

(degrees of
severity)

Alternative Names Return to top

Spina bifida; Cleft spine

Definition Return to top

Myelomeningocele is a birth defect in which the backbone and spinal canal do not close before birth. The
condition is a type of spina bifida.

Causes Return to top

Myelomeningocele is one of the most common birth defects of the central nervous system. It is a neural tube
defect in which the bones of the spine do not completely form, resulting in an incomplete spinal canal. This
causes the spinal cord and meninges (the tissues covering the spinal cord) to stick out of the child's back.

Myelomeningocele accounts for about 75% of all cases of spina bifida and may affect as many as 1 out of every
800 infants. Spina bifida includes any birth defect involving insufficient closure of the spine.

The rest of myelomeningocele cases are most commonly:

• Spina bifida occulta, a condition in which the bones of the spine do not close but the spinal cord and
meninges remain in place and skin usually covers the defect
• Meningoceles, a condition where the tissue covering the spinal cord sticks out of the spinal defect but
the spinal cord remains in place.

Other congenital disorders may also be present in the child. Hydrocephalus may affect as many as 90% of
children with myelomeningocele. Other disorders of the spinal cord or musculoskeletal system may be seen,
including syringomyelia and hip dislocation.
The cause of myelomeningocele is unknown. However, folic acid deficiency is thought to play a part in neural
tube defects. Also, if a child is born with myelomeningocele, subsequent children in that family have a higher
risk than the general population.

Some theorize that a virus make play a role, since there is a higher rate of this condition in children born in the
early winter months. Research also indicates possible environmental factors such as radiation.

Symptoms Return to top

A newborn may have a sac sticking out of the mid to lower back. The doctor cannot see through the sac when
shining a light behind it. Symptoms include:

• Loss of bladder or bowel control

• Partial or complete lack of sensation
• Partial or complete paralysis of the legs
• Weakness of the hips, legs, or feet of a newborn

The exposed spinal cord is susceptible to infection. Other symptoms may include:

• Hair at the back part of the pelvis called the sacral area
• Dimpling of the sacral area

Exams and Tests Return to top

Prenatal screening can help diagnose this condition. During the first trimester, pregnant women can have a
blood test called a triple screen. This test screens for myelomeningocele, Down syndrome, and other congenital
diseases in the baby. Most women carrying a baby with spina bifida will have a higher-than-normal levels of a
protein called maternal alpha fetoprotein (AFP).

If the triple screen test is position, further testing is needed to confirm the diagnosis. Such tests may include:

• Pregnancy ultrasound
• Amniocentesis

Myelomeningocele can be seen after the child is born. A neurologic examination may show that the child has
loss of nerve-related functions below the defect. For example, watching how the infant responds to pinpricks at
various locations may reveal where he or she can feel the sensations.

Tests done on the baby after birth may include x-rays, ultrasound, CT, or MRI of the spinal area.

Treatment Return to top

Genetic counseling may be recommended. In some cases where severe defect is detected early in the
pregnancy, a therapeutic abortion may be considered.

After birth, surgery to repair the defect is usually recommended at an early age. Before surgery, the infant must
be handled carefully to reduce damage to the exposed spinal cord. This may include special care and
positioning, protective devices, and changes in the methods of handling, feeding, and bathing.

Antibiotics may be used to treat or prevent infections such as meningitis or urinary tract infections.

Gentle downward pressure over the bladder may help drain the bladder. In severe cases, drainage tubes, called
catheters, may be needed. Bowel training programs and a high fiber diet may improve bowel function.
Orthopedic or physical therapy may be needed to treat musculoskeletal symptoms. Neurological losses are
treated according to the type and severity of function loss.

Follow-up neurologic testing as the child gets older helps to guide rehabilitation.

Support Groups Return to top

See: Spina bifida resources

Outlook (Prognosis) Return to top

A myelomeningocele can usually be surgically corrected. With treatment, length of life is not severely affected.
Neurological damage is often irreversible.

Possible Complications Return to top

• Difficult delivery with problems resulting from a traumatic birth, including cerebral palsy and decreased
oxygen to the brain
• Frequent urinary tract infections
• Hydrocephalus
• Loss of bowel or bladder control
• Meningitis
• Permanent weakness or paralysis of legs

This list may not be all inclusive.

When to Contact a Medical Professional Return to top

Call your health care provider if:

• A sac sticks out of the spine of a newborn infant.

• The child is late in walking or crawling
• Symptoms of hydrocephalus develop, including bulging soft spot, irritability, extreme sleepiness, and
feeding difficulties
• Symptoms of menigitis develop, including fever, stiff neck, irritability, and a high-pitched cry

Prevention Return to top

Folic acid supplements may help reduce the risk of neural tube defects such as myelomeningocele. It is
recommended that any woman considering becoming pregnant take 0.4 mg of folic acid a day. Pregnant women
need 1 mg per day.

It is important to remember that folic acid deficiencies must be corrected before becoming pregnant as the
defects develop very early.

Prospective mothers may be screened to determine the amount of folic acid in their blood.

Update Date: 10/11/2007