Skip to Main Content


Congenital defect of spine and spinal cord.


Approximately 1:1000 live births. Risk in a subsequent sibling is 3 to 4% and up to 10% with two previously affected siblings.


Unclear. Genetic predisposition is clearly seen in the increased incidence among siblings, but nutritional and environmental factors also have a role in the pathogenesis.


Arises from the failure of the fetal neural tube to close within the first 3 weeks of gestation. This leads to the incomplete fusion of the posterior lamina and spines of the vertebral column, most commonly in the lumbosacral segments. The underlying spinal cord tissue may also have developmental abnormalities, including syringomyelia, diastematomyelia, and a tethered cord.


Clinical and radiological features. Investigation of the abnormal spine includes plain radiograph, CT scan, and MRI with or without contrast. CT scan of head is also recommended to assess the presence of hydrocephalus and other neural abnormalities. Prenatal diagnosis can be made by demonstration of the defect on ultrasonography and the detection of alpha-fetoprotein in amniotic fluid. Alpha-fetoprotein in maternal serum is an effective test for screening in high-risk patient.


In Spina Bifida Occulta, there is a midline defect of the spinal column without protrusion of the spinal cord or meninges. Most affected individuals are asymptomatic and lack neurological signs. In some cases, it may be associated with patches of hair, a lipoma, discoloration of the skin, or a dermal sinus in the midline of the low back. In meningocele, the meninges herniate through the defect, but the spinal cord assumes normal position in the spinal canal. The spinal cord may or may not be normal.


In Meningomyelocele, various amounts of neural tissue and meninges herniate through the defect to form a sac-like cystic structure covered by a thin layer of skin tissue that may rupture and leak cerebrospinal fluid. Early repair and closure is recommended to reduce the risk of infection and to preserve neurological function. The extent of the neurological deficit depends greatly on the location of the meningomyelocele; it most commonly occurs in the lumbosacral region. The conus medullaris is usually disrupted and abnormal. Clinical features include flaccid paralysis of the lower limbs, absence of deep tendon reflexes, lack of response to touch and pain, and urinary and fecal incontinence. Lesions above T4 generally result in paraplegia, whereas lesions below S1 allow ambulation. Hydrocephalus in association with a type II Arnold-Chiari Malformation occurs in many of these patients. Postural abnormalities of the lower limbs including clubfeet and subluxation of the hip are also common.


Obtain a full history, including perinatal history, previous anesthesia and surgical procedures, and any known allergies. Neurological examination to document the motor, sensory, and autonomic functions and the presence of hydrocephalus. Assess presence of coexisting disease. Assess volume status and rehydrate if required.


For infants who present for meningomyelocele repair, protect the neural sac ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.


Create a Free MyAccess Profile

* Required Fields

Note: If you have registered for a MyAccess profile on any of the Access sites, you can use the same MyAccess login credentials across all sites.

Passwords must be between 6 and 40 characters long (no whitespace), cannot contain characters #, &, and must contain:
  • at least one lowercase letter
  • at least one uppercase letter
  • at least one digit

Benefits of a MyAccess Profile:

  • Remote access to the site off-campus on any device
  • Notification of new content via custom alerts
  • Bookmark your favorite content such as chapters, figures, tables, videos, cases and more
  • Save and download images to PowerPoint
  • Self-Assessment quizzes saved for quick review
  • Custom Curriculum access for both instructors and learners

Subscription Options

AccessAnesthesiology Full Site: One-Year Subscription

Connect to the full suite of AccessAnesthesiology content and resources including procedural videos, interactive self-assessment, real-life cases, 20+ textbooks, and more

$995 USD
Buy Now

Pay Per View: Timed Access to all of AccessAnesthesiology

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.