spina bifida occulta symptoms Spine Bifida Occulta | Importance in Recognizing it

Spine Bifida Occulta | Importance in Recognizing it

The term spina bifida (EB), or spinal dysraphism, refers to closure defects of the neural tube / neural arch during its intrauterine formation process (the caudal neuropore closes at the 28th day of intrauterine life). The neural arch, consisting of transverse processes, blades and spinous processes, is malformed, with absence of spinous processes in all cases, and variable defects of closure of the vertebral lamina in the others.

EB is most often found in the lumbar or lumbosacral region. The spina bifida can be classified as cystic (EBC) or "hidden" (EBO). Cystic cases are manifested by coarse cutaneous defects, readily identified postnatal, through cystic dilatation of the meningeal (meningocele) or, more often, meningeal, malformed neural content and cerebrospinal fluid (CSF) (myelomeningocele, with an incidence of 0.1 to 0.2%) (Figure 1). In a situation of EBC with spontaneous CSF, the indication of operative correction becomes urgent, due to the imminent risk of infection of the central nervous system.

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Figure 1

EBO, much more frequently (incidence of 5 to 10% of the population), presents less severe neural artery closure defects, with no visible meningeal or neural tissue exposure. Most children with EBO do not present any neurological deficit, but may present the so-called cutaneous stigmata of the neural arch defect, which may be present in the lumbar or lumbosacral midline. Several of these lesions have already been described as pigmented spots, hyperchromic patches with presence of hair, multiple petechiae, lipomas of different extensions, cutaneous appendages, dermal sinuses, among others (Figures 2 and 3).

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Figures 2 and 3

This is a matter of great clinical relevance, as children are often taken to the general surgeon or plastic surgeon for evaluation and removal of lesions located there. However, any lumbar or lumbosacral dorsal midline skin lesion should be evaluated by a neurosurgeon prior to removal. This is because the presence of underlying meninges or neural tissue should be ruled out by lumbosacral spine magnetic resonance imaging. Children with cutaneous stigmas and neurological symptoms of spinal cord (gait difficulty, back pain and muscular atrophy in the lower limbs) present a defect in the closure of lumbar or lumbosacral blades 98% of the time. Thus, the knowledge of this condition and the recognition of the presence of eventual EBO requires specialized evaluation, reducing the risk of meningeal or neural injury due to inadvertent surgical removal of mid-lumbar skin lesion.

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