The hidden spina bifida is a congenital alteration due to defects in the development of the neural tube. If it is the first time you hear these names I recommend you read the post about neural tube embryology, where I explain it in a simple way, and we will understand better the post today. In the development of the spine, during our life in the womb of our mother, a defect in the closing or final fusion of the vertebral bodies may occur.
In the case of hidden spina bifida there is a defect in the fusion of the posterior arches of the vertebrae but without any exposed neurological tissue. The skin covers the defect and simply lacks bone in the back of the vertebrae.
I have a hidden spina bifida, is it serious?
Most people diagnosed with a hidden spina bifida are by chance. The most common is to see the defect in an X-ray that we have performed for low back pain or another reason. In these cases we see the bone defect without other problems and are not accompanied by any significant symptoms. This is the usual situation when the diagnosis is made in adulthood.
It is possible that this defect of the development yes of some problems. The most significant problems are seen in patients with a “true” spina bifida, which, as we will see in other posts, carries deformities that affect the nervous tissue. In hidden spina bifida it is more rare that there are neurological problems and are due more too associated alterations than to the own closure defect in the column.
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In children there are some signs that may make us suspect it indirectly, such as, for example, alterations in the skin in the lower back. Areas of excess or lack of pigmentation, hyperkeratosis (tissue as if it were a scar), dimples or lumps may be found among others. If we see these problems it is a good idea to consult with the pediatrician about the possibility of a hidden spina bifida.
Although rare as we have discussed, neurological damage can also occur, that is, impaired nerve structures down the spinal cord. This has consequences that may be delayed due to the development of the child:
– The most common is the impairment in the ability to urinate normally, such as urinary incontinence or urine retention. Sometimes we suspect it in children who have many urine infections.
– Another typical symptom of neurological involvement is constipation that does not improve with conventional measures.
– It can also affect the nerves that go to the legs and notice weakness.
– Deformities can occur in the feet, in the spine (scoliosis and hyperciphosis) and dysmetria (different length of the legs).
– Sensitivity may be affected in the legs and in the genital and perianal area. Sometimes it is suspected by injuries or abnormal damages that we see in the skin without the child showing pain or complaining.
It is necessary to emphasize that to have some of these symptoms does not give the diagnosis, but it is advisable to visit our pediatrician. For example, if you see dimples in the lower back, in most cases you will not have hidden spina bifida. I say this so that no one is alarmed or overconfident and just check with your pediatrician.
Is it important to detect hidden spina bifida?
Fortunately in many cases it will have no consequences and we will detect it in our adult life, as we have commented. In children, it is important to detect it because it can begin to be asymptomatic and that the symptoms progress slowly. As discussed earlier, problems come primarily from associated injuries that may appear; Such as lipomas. These problems can cause a compression on the nerves and progressively more. If we detect it in time we can correct it with surgery and avoid future problems.
The fact that the lesion can be progressive and progressively worse makes detection very important as soon as possible. The way to detect it is to suspect it if a child is having any of the symptoms described above. Sometimes it is complicated because the child has not yet learned to walk or control the sphincters.
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What tests can help the diagnosis of hidden spina bifida?
The most important test is magnetic resonance imaging (MRI) that must be done for the entire spine. Sometimes there are malformations at several sites in the spine so the full study is recommended. With an x-ray we can see the bone defect or, better yet, with a CT scanner.
There are other tests such as ultrasound or urodynamic study that can give direct or indirect signs of dysfunction of the urinary tract suggesting neurological damage.