 Hi and welcome to Nursing School Explained. Today's topic is spina bifida or neural tube defects. So let's take a look at this. So spina bifida is defined as a neural tube defect due to incomplete closure of the vertebra and the neural tube in utero. So keep in mind when the embryo first develops, it's basically just a, it starts as a tube that eventually grows and grows and grows and then it develops into the brain, the spinal cord and then all the limbs and so forth develop. And when there's a neural tube defect, it usually happens in the first three to four weeks of pregnancy when the neural tube starts to bend and fold in week five. Now, the neural tube defect usually occurs at the level of L5 to S1. Let's take a look at the different levels of neural tube defects that can happen here. So I have drawn out the vertebra here in pink, the nerve roots in blue and then the layer of skin on the back, basically in green. So if you look at it here, the vertebra, every nerve root innervates a vertebra and then it's covered by the layer of skin. And then spina bifida or colta that basically just means that there's a tiny little gap here and there may be a tuft of hair at that level of the L5 to S1. So there's no herniation of the spinal cord or the meninges. And remember the meninges is kind of like the lining of the brain and the central nervous system, including the brain and the spinal cord. Where in spina bifida cystica, we have to distinguish between meningocel and the myelomeningocel. So in meningocel, again, we have our vertebra and the nerve roots. And then because that neural tube defect here, we have this sac-like protrusion here that is filled with cerebral spinal fluid. Remember that the brain and spinal cord are cushioned by cerebral spinal fluid to allow for movement and lubrication. So in this case, there's this protrusion here, this herniation that's filled with cerebral spinal fluid. Now in myeloma ninja steel, we again have this sac-like protrusion, but now there's not only CSF in here, but also some of these nerve roots are coiled up in the sac and basically protruding, herniating into there. And then the severity of symptoms that the patient will have will depend on the level. So is there herniation? Is there only CSF that's protruding or are there also nerve roots that have escaped into the sac-like protrusion? Now, keep in mind that all the different vertebra control different levels of organs and also controlling the lower extremities. So the more severe the nerve roots are involved and kind of tangled up in the sac-like protrusion, the more severe the patient's symptoms will be. And at the level of L5S1 is where the nerve roots break off that also control the bladder and bowel and will come and look at those complications in the bit here. Now causes, typically unknown, but neural tube defects are linked to maternal folic acid deficiency. And the problem with this really is that this neural tube defect happens so early in the pregnancy in three to four weeks of gestation that some women might not even know that they are pregnant and they might not know that they are folic acid deficient, which is why the recommendation is that any woman who is trying to conceive or of childbearing age should either take prenatal vitamins, including folic acid or just a folic acid supplement to make sure that they have enough folic acid in their system to hopefully prevent that neural tube defect that happens early in the pregnancy. Now for signs and symptoms, they will depend on the degree of the protrusion. So it will depend if it's funnabifida occulta or if it's cystica with meningocel or myeloma meningocel. So again, depending on if the nerve roots are involved or not, the patient might have no motor impairment. They might have complete control over their lower extremities or they might have completely flaccid lower extremities depending on how many nerve roots and what nerve roots are really involved here. Now the diagnosis of spina bifida usually happens with an alpha fetal protein test that's 16 to 18 weeks of gestation. And if that comes out positive, usually an amniocetesis and fetal ultrasound are recommended to investigate a little bit further. There are a couple of different treatment options. So first, this has to be surgically repaired. So first option is to do this in utero prenatally. And this can be done at 19 to 20 feet, five weeks of gestation. And you can imagine what kind of complications can happen here when the baby is still in utero and you're trying to have surgery on that embryo or that infant in this case. But the advantage is if it's done prenatally, there's a decreased incidence of hydrocephalus and chiari malformation. And hydrocephalus I'll be discussing in more detail in a different video, but chiari malformation basically means that this is the spinal cord here in blue and on top we have the brain. So if there is now a protrusion over here, parts of the brain depending on the severity of the sac and the level of protrusion or herniation, it can create a suctioning effect, which means that part of the brain can kind of get sucked down into the spinal cord. And this is called a chiari malformation. And then that might have complications as of developmental and cognitive complications in the patient. So prenatal surgery, which was discussed of the benefit is that it would decrease that sucking of the brain down into the spinal canal, hopefully preventing some of those complications. Now we can also, a surgery is also performed postpartum, but there is an increased risk of infection and death in the infant. Just imagine this is a very delicate sac that's sometimes even almost kind of like see through. And we don't want to, when this patient is born, they're usually born by C-section because squeezing the infant through the birth canal might disrupt this sac and then the contents will spill and causing a whole lot of problems here. But also postpartum surgery will put the patient an increased risk of infection. And because again of the degree of the nerve root involvement here, the patient will need lifelong management of their orthopedic, neural and urinary problems. And let's just skip down here to most common complications are neurogenic bladder and neurogenic bowel. Again, because if these nerve roots that usually control bladder and bowel function are impaired because of this myeloma ninja seal, the bladder and bowel function are not going to be intact, which a lot of times means that the patient won't have control or the sensation that they need to urinate or depicate, which sometimes will need them to need to do perform self catheterization in order to empty the bladder. And another complication is constipation because again, they don't get the sensation that they have to depicate. Therefore, there's going to be very strict bowel regimen keeping them hydrated so that they can actually depicate hopefully normally. And then postdoc management, if this is done postpartum, you definitely want to monitor for leakage from that repair sack because that could be cerebral spinal fluid that's escaping there. We certainly want to assess for infection. Imagine if you have now surgically removed the sack and kind of repaired these nerve roots and now you have an infection, it's a direct pathway into the central nervous system through the cerebral spinal fluid that can lead to an infection in the brain, so meningitis and syphilitis. And then as well, we want to assess distal sensation because again, these nerve roots control the lower extremities. So we want to make sure to see is there sensation? Is there movement? How is the patient doing postoperatively? And another complication is hydrocephalus which I'll be discussing in a different video here in and on itself. So in summary, spina bifida is a chronic neurological or orthopedic and neurological disorder that happens early on in development. It can be linked to maternal folic acid deficiency so it is recommended that women of childbearing age have appropriate levels of folic acid in their system so that during early fetal development the snorkel tube develops normally and spina bifida is prevented. Thanks for watching Nursing School Explained. I look forward to seeing you next time. Have a wonderful day.