Spina bifida is a spectrum of congenital malformations in which the neural tube does not close during embryonic development. Spina bifida represents a range of diseases including spina bifida occulta, in which the posterior bony elements fail to fuse but the dura and neural elements remain unaffected; meningocele, in which the posterior bony elements fail to fuse and the dura and arachnoid tissue form a sac that protrudes from the bony defect; and last, myelomeningocele, where posterior bony elements fail to fuse, and the sac that protrudes through the bony defect includes not only dura and arachnoid but spinal cord and neural elements (Figure 1). Spina bifida occulta is so named because it is “occult,” or hidden by a layer of skin that covers the malformation of the bone. Spina bifida occulta is present in 10% or more of the general population and rarely causes signs or symptoms. Some individuals with meningocele may have few or no symptoms yet some may have varying degrees of paralysis and bladder and bowel dysfunction. Myelomeningocele uniformly results in partial or complete dysfunction of the nerves below the spinal opening, which leads to paralysis and bladder and bowel dysfunction.
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