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class="vector-toc-list"> </ul> </li> <li id="toc-Meningocele" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Meningocele"> <div class="vector-toc-text"> 1.2 Meningocele </div> </a> <ul id="toc-Meningocele-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Myelomeningocele" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Myelomeningocele"> <div class="vector-toc-text"> 1.3 Myelomeningocele </div> </a> <ul id="toc-Myelomeningocele-sublist" class="vector-toc-list"> <li id="toc-Myelocele" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Myelocele"> <div class="vector-toc-text"> 1.3.1 Myelocele </div> </a> <ul id="toc-Myelocele-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> </ul> </li> <li id="toc-Signs_and_symptoms" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Signs_and_symptoms"> <div class="vector-toc-text"> 2 Signs and symptoms </div> </a> <button aria-controls="toc-Signs_and_symptoms-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> Toggle Signs and symptoms subsection </button> <ul id="toc-Signs_and_symptoms-sublist" class="vector-toc-list"> <li id="toc-Physical_problems" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Physical_problems"> <div class="vector-toc-text"> 2.1 Physical problems </div> </a> <ul id="toc-Physical_problems-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Neurological_problems" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Neurological_problems"> <div class="vector-toc-text"> 2.2 Neurological problems </div> </a> <ul id="toc-Neurological_problems-sublist" class="vector-toc-list"> <li id="toc-Executive_function" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Executive_function"> <div class="vector-toc-text"> 2.2.1 Executive function </div> </a> <ul id="toc-Executive_function-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Academic_skills" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Academic_skills"> <div class="vector-toc-text"> 2.2.2 Academic skills </div> </a> <ul id="toc-Academic_skills-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> </ul> </li> <li id="toc-Cause" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Cause"> <div class="vector-toc-text"> 3 Cause </div> </a> <ul id="toc-Cause-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Pathophysiology" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Pathophysiology"> <div class="vector-toc-text"> 4 Pathophysiology </div> </a> <ul id="toc-Pathophysiology-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Prevention" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Prevention"> <div class="vector-toc-text"> 5 Prevention </div> </a> <ul id="toc-Prevention-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Screening" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Screening"> <div class="vector-toc-text"> 6 Screening </div> </a> <ul id="toc-Screening-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Treatment" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Treatment"> <div class="vector-toc-text"> 7 Treatment </div> </a> <button aria-controls="toc-Treatment-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> Toggle Treatment subsection </button> <ul id="toc-Treatment-sublist" class="vector-toc-list"> <li id="toc-Pregnancy" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Pregnancy"> <div class="vector-toc-text"> 7.1 Pregnancy </div> </a> <ul id="toc-Pregnancy-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Childhood" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Childhood"> <div class="vector-toc-text"> 7.2 Childhood </div> </a> <ul id="toc-Childhood-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Transition_to_adulthood" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Transition_to_adulthood"> <div class="vector-toc-text"> 7.3 Transition to adulthood </div> </a> <ul id="toc-Transition_to_adulthood-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Epidemiology" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Epidemiology"> <div class="vector-toc-text"> 8 Epidemiology </div> </a> <ul id="toc-Epidemiology-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-History" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#History"> <div class="vector-toc-text"> 9 History </div> </a> <ul id="toc-History-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Research" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Research"> <div class="vector-toc-text"> 10 Research </div> </a> <button aria-controls="toc-Research-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> Toggle Research subsection </button> <ul id="toc-Research-sublist" class="vector-toc-list"> <li id="toc-MOMS_trial" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#MOMS_trial"> <div class="vector-toc-text"> 10.1 MOMS trial </div> </a> <ul id="toc-MOMS_trial-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Fetoscopic_surgery" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Fetoscopic_surgery"> <div class="vector-toc-text"> 10.2 Fetoscopic surgery </div> </a> <ul id="toc-Fetoscopic_surgery-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Placenta" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Placenta"> <div class="vector-toc-text"> 10.3 Placenta </div> </a> <ul id="toc-Placenta-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-See_also" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#See_also"> <div class="vector-toc-text"> 11 See also </div> </a> <ul id="toc-See_also-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-References" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#References"> <div class="vector-toc-text"> 12 References </div> </a> <ul id="toc-References-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-External_links" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#External_links"> <div class="vector-toc-text"> 13 External links </div> </a> <ul id="toc-External_links-sublist" class="vector-toc-list"> </ul> </li> </ul> </div> </div> </nav> </div> </div> <div class="mw-content-container"> <main id="content" class="mw-body"> <header class="mw-body-header vector-page-titlebar"> <nav aria-label="Contents" class="vector-toc-landmark"> <div id="vector-page-titlebar-toc" class="vector-dropdown vector-page-titlebar-toc vector-button-flush-left" > <input type="checkbox" id="vector-page-titlebar-toc-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-vector-page-titlebar-toc" class="vector-dropdown-checkbox " aria-label="Toggle the table of contents" > <label id="vector-page-titlebar-toc-label" for="vector-page-titlebar-toc-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--icon-only " aria-hidden="true" > Toggle the table of contents </label> <div class="vector-dropdown-content"> <div id="vector-page-titlebar-toc-unpinned-container" class="vector-unpinned-container"> </div> </div> </div> </nav> <h1 id="firstHeading" class="firstHeading mw-first-heading">Spina bifida</h1> <div id="p-lang-btn" class="vector-dropdown mw-portlet mw-portlet-lang" > <input type="checkbox" id="p-lang-btn-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-p-lang-btn" class="vector-dropdown-checkbox mw-interlanguage-selector" aria-label="Go to an article in another language. Available in 41 languages" > <label id="p-lang-btn-label" for="p-lang-btn-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--action-progressive mw-portlet-lang-heading-41" aria-hidden="true" > 41 languages </label> <div class="vector-dropdown-content"> <div class="vector-menu-content"> <ul class="vector-menu-content-list"> <li class="interlanguage-link interwiki-ar mw-list-item"><a href="https://ar.wikipedia.org/wiki/%D8%AA%D8%B4%D9%82%D9%82_%D8%A7%D9%84%D8%B9%D9%85%D9%88%D8%AF_%D8%A7%D9%84%D9%81%D9%82%D8%B1%D9%8A" title="تشقق العمود الفقري – Arabic" lang="ar" hreflang="ar" data-title="تشقق العمود الفقري" data-language-autonym="العربية" data-language-local-name="Arabic" class="interlanguage-link-target">العربية</a></li><li class="interlanguage-link interwiki-bg mw-list-item"><a href="https://bg.wikipedia.org/wiki/%D0%A1%D0%BF%D0%B8%D0%BD%D0%B0_%D0%B1%D0%B8%D1%84%D0%B8%D0%B4%D0%B0" title="Спина бифида – Bulgarian" lang="bg" hreflang="bg" data-title="Спина бифида" data-language-autonym="Български" data-language-local-name="Bulgarian" class="interlanguage-link-target">Български</a></li><li class="interlanguage-link interwiki-bs mw-list-item"><a href="https://bs.wikipedia.org/wiki/Spina_bifida" title="Spina bifida – Bosnian" lang="bs" hreflang="bs" data-title="Spina bifida" data-language-autonym="Bosanski" data-language-local-name="Bosnian" class="interlanguage-link-target">Bosanski</a></li><li class="interlanguage-link interwiki-ca mw-list-item"><a href="https://ca.wikipedia.org/wiki/Espina_b%C3%ADfida" title="Espina bífida – Catalan" lang="ca" hreflang="ca" data-title="Espina bífida" data-language-autonym="Català" data-language-local-name="Catalan" class="interlanguage-link-target">Català</a></li><li class="interlanguage-link interwiki-cy mw-list-item"><a href="https://cy.wikipedia.org/wiki/Spina_bifida" title="Spina bifida – Welsh" lang="cy" hreflang="cy" data-title="Spina bifida" data-language-autonym="Cymraeg" data-language-local-name="Welsh" class="interlanguage-link-target">Cymraeg</a></li><li class="interlanguage-link interwiki-de mw-list-item"><a href="https://de.wikipedia.org/wiki/Spina_bifida" title="Spina bifida – German" lang="de" hreflang="de" data-title="Spina bifida" data-language-autonym="Deutsch" data-language-local-name="German" class="interlanguage-link-target">Deutsch</a></li><li class="interlanguage-link interwiki-dv mw-list-item"><a href="https://dv.wikipedia.org/wiki/%DE%90%DE%B0%DE%95%DE%A6%DE%87%DE%A8%DE%82%DE%A7_%DE%84%DE%A8%DE%8A%DE%A8%DE%91%DE%A7" title="ސްޕައިނާ ބިފިޑާ – Divehi" lang="dv" hreflang="dv" data-title="ސްޕައިނާ ބިފިޑާ" data-language-autonym="ދިވެހިބަސް" data-language-local-name="Divehi" class="interlanguage-link-target">ދިވެހިބަސް</a></li><li class="interlanguage-link interwiki-el mw-list-item"><a href="https://el.wikipedia.org/wiki/%CE%94%CE%B9%CF%83%CF%87%CE%B9%CE%B4%CE%AE%CF%82_%CF%81%CE%AC%CF%87%CE%B7" title="Δισχιδής ράχη – Greek" lang="el" hreflang="el" data-title="Δισχιδής ράχη" data-language-autonym="Ελληνικά" data-language-local-name="Greek" class="interlanguage-link-target">Ελληνικά</a></li><li class="interlanguage-link interwiki-es mw-list-item"><a href="https://es.wikipedia.org/wiki/Espina_b%C3%ADfida" title="Espina bífida – Spanish" lang="es" hreflang="es" data-title="Espina bífida" data-language-autonym="Español" data-language-local-name="Spanish" class="interlanguage-link-target">Español</a></li><li class="interlanguage-link interwiki-eo mw-list-item"><a href="https://eo.wikipedia.org/wiki/Malfermita_spino" title="Malfermita spino – Esperanto" lang="eo" hreflang="eo" data-title="Malfermita spino" data-language-autonym="Esperanto" data-language-local-name="Esperanto" class="interlanguage-link-target">Esperanto</a></li><li class="interlanguage-link interwiki-eu mw-list-item"><a href="https://eu.wikipedia.org/wiki/Arantza_bifido" title="Arantza bifido – Basque" lang="eu" hreflang="eu" data-title="Arantza bifido" data-language-autonym="Euskara" data-language-local-name="Basque" class="interlanguage-link-target">Euskara</a></li><li class="interlanguage-link interwiki-fa mw-list-item"><a href="https://fa.wikipedia.org/wiki/%D9%85%D9%87%D8%B1%D9%87%E2%80%8C%D8%B4%DA%A9%D8%A7%D9%81" title="مهره‌شکاف – Persian" lang="fa" hreflang="fa" data-title="مهره‌شکاف" data-language-autonym="فارسی" data-language-local-name="Persian" class="interlanguage-link-target">فارسی</a></li><li class="interlanguage-link interwiki-fr mw-list-item"><a href="https://fr.wikipedia.org/wiki/Spina_bifida" title="Spina bifida – French" lang="fr" hreflang="fr" data-title="Spina bifida" data-language-autonym="Français" data-language-local-name="French" class="interlanguage-link-target">Français</a></li><li class="interlanguage-link interwiki-ga mw-list-item"><a href="https://ga.wikipedia.org/wiki/Spina_bifida" title="Spina bifida – Irish" lang="ga" hreflang="ga" data-title="Spina bifida" data-language-autonym="Gaeilge" data-language-local-name="Irish" class="interlanguage-link-target">Gaeilge</a></li><li class="interlanguage-link interwiki-ko mw-list-item"><a href="https://ko.wikipedia.org/wiki/%EC%B2%99%EC%B6%94%EA%B0%88%EB%A6%BC%EC%A6%9D" title="척추갈림증 – Korean" lang="ko" hreflang="ko" data-title="척추갈림증" data-language-autonym="한국어" data-language-local-name="Korean" class="interlanguage-link-target">한국어</a></li><li class="interlanguage-link interwiki-hy mw-list-item"><a href="https://hy.wikipedia.org/wiki/%D5%8D%D5%BA%D5%AB%D5%B6%D5%A1_%D5%A2%D5%AB%D6%86%D5%AB%D5%A4%D5%A1" title="Սպինա բիֆիդա – Armenian" lang="hy" hreflang="hy" data-title="Սպինա բիֆիդա" data-language-autonym="Հայերեն" data-language-local-name="Armenian" class="interlanguage-link-target">Հայերեն</a></li><li class="interlanguage-link interwiki-id mw-list-item"><a href="https://id.wikipedia.org/wiki/Spina_bifida" title="Spina bifida – Indonesian" lang="id" hreflang="id" data-title="Spina bifida" data-language-autonym="Bahasa Indonesia" data-language-local-name="Indonesian" class="interlanguage-link-target">Bahasa Indonesia</a></li><li class="interlanguage-link interwiki-ia mw-list-item"><a href="https://ia.wikipedia.org/wiki/Spina_bifida" title="Spina bifida – Interlingua" lang="ia" hreflang="ia" data-title="Spina bifida" data-language-autonym="Interlingua" data-language-local-name="Interlingua" class="interlanguage-link-target">Interlingua</a></li><li class="interlanguage-link interwiki-it mw-list-item"><a href="https://it.wikipedia.org/wiki/Spina_bifida" title="Spina bifida – Italian" lang="it" hreflang="it" data-title="Spina bifida" data-language-autonym="Italiano" data-language-local-name="Italian" class="interlanguage-link-target">Italiano</a></li><li class="interlanguage-link interwiki-he mw-list-item"><a href="https://he.wikipedia.org/wiki/%D7%A1%D7%A4%D7%99%D7%A0%D7%94_%D7%91%D7%99%D7%A4%D7%99%D7%93%D7%94" title="ספינה ביפידה – Hebrew" lang="he" hreflang="he" data-title="ספינה ביפידה" data-language-autonym="עברית" data-language-local-name="Hebrew" class="interlanguage-link-target">עברית</a></li><li class="interlanguage-link interwiki-la mw-list-item"><a href="https://la.wikipedia.org/wiki/Spina_bifida" title="Spina bifida – Latin" lang="la" hreflang="la" data-title="Spina bifida" data-language-autonym="Latina" data-language-local-name="Latin" class="interlanguage-link-target">Latina</a></li><li class="interlanguage-link interwiki-hu mw-list-item"><a href="https://hu.wikipedia.org/wiki/Nyitott_gerinc" title="Nyitott gerinc – Hungarian" lang="hu" hreflang="hu" data-title="Nyitott gerinc" data-language-autonym="Magyar" data-language-local-name="Hungarian" class="interlanguage-link-target">Magyar</a></li><li class="interlanguage-link interwiki-nl mw-list-item"><a href="https://nl.wikipedia.org/wiki/Open_rug" title="Open rug – Dutch" lang="nl" hreflang="nl" data-title="Open rug" data-language-autonym="Nederlands" data-language-local-name="Dutch" class="interlanguage-link-target">Nederlands</a></li><li class="interlanguage-link interwiki-ja mw-list-item"><a href="https://ja.wikipedia.org/wiki/%E4%BA%8C%E5%88%86%E8%84%8A%E6%A4%8E%E7%97%87" title="二分脊椎症 – Japanese" lang="ja" hreflang="ja" data-title="二分脊椎症" data-language-autonym="日本語" data-language-local-name="Japanese" class="interlanguage-link-target">日本語</a></li><li class="interlanguage-link interwiki-no mw-list-item"><a href="https://no.wikipedia.org/wiki/Ryggmargsbrokk" title="Ryggmargsbrokk – Norwegian Bokmål" lang="nb" hreflang="nb" data-title="Ryggmargsbrokk" data-language-autonym="Norsk bokmål" data-language-local-name="Norwegian Bokmål" class="interlanguage-link-target">Norsk bokmål</a></li><li class="interlanguage-link interwiki-or mw-list-item"><a href="https://or.wikipedia.org/wiki/%E0%AC%B8%E0%AD%8D%E0%AC%AA%E0%AC%BE%E0%AC%87%E0%AC%A8%E0%AC%BE_%E0%AC%AC%E0%AC%BE%E0%AC%87%E0%AC%AB%E0%AC%BF%E0%AC%A1%E0%AC%BE" title="ସ୍ପାଇନା ବାଇଫିଡା – Odia" lang="or" hreflang="or" data-title="ସ୍ପାଇନା ବାଇଫିଡା" data-language-autonym="ଓଡ଼ିଆ" data-language-local-name="Odia" class="interlanguage-link-target">ଓଡ଼ିଆ</a></li><li class="interlanguage-link interwiki-uz mw-list-item"><a href="https://uz.wikipedia.org/wiki/Spina_bifida" title="Spina bifida – Uzbek" lang="uz" hreflang="uz" data-title="Spina bifida" data-language-autonym="Oʻzbekcha / ўзбекча" data-language-local-name="Uzbek" class="interlanguage-link-target">Oʻzbekcha / ўзбекча</a></li><li class="interlanguage-link interwiki-pl mw-list-item"><a href="https://pl.wikipedia.org/wiki/Rozszczep_kr%C4%99gos%C5%82upa" title="Rozszczep kręgosłupa – Polish" lang="pl" hreflang="pl" data-title="Rozszczep kręgosłupa" data-language-autonym="Polski" data-language-local-name="Polish" class="interlanguage-link-target">Polski</a></li><li class="interlanguage-link interwiki-pt mw-list-item"><a href="https://pt.wikipedia.org/wiki/Espinha_b%C3%ADfida" title="Espinha bífida – Portuguese" lang="pt" hreflang="pt" data-title="Espinha bífida" data-language-autonym="Português" data-language-local-name="Portuguese" class="interlanguage-link-target">Português</a></li><li class="interlanguage-link interwiki-ro mw-list-item"><a href="https://ro.wikipedia.org/wiki/Spin%C4%83_bifid%C4%83" title="Spină bifidă – Romanian" lang="ro" hreflang="ro" data-title="Spină bifidă" data-language-autonym="Română" data-language-local-name="Romanian" class="interlanguage-link-target">Română</a></li><li class="interlanguage-link interwiki-ru mw-list-item"><a href="https://ru.wikipedia.org/wiki/%D0%A0%D0%B0%D1%81%D1%89%D0%B5%D0%BF%D0%BB%D0%B5%D0%BD%D0%B8%D0%B5_%D0%BF%D0%BE%D0%B7%D0%B2%D0%BE%D0%BD%D0%BE%D1%87%D0%BD%D0%B8%D0%BA%D0%B0" title="Расщепление позвоночника – Russian" lang="ru" hreflang="ru" data-title="Расщепление позвоночника" data-language-autonym="Русский" data-language-local-name="Russian" class="interlanguage-link-target">Русский</a></li><li class="interlanguage-link interwiki-simple mw-list-item"><a href="https://simple.wikipedia.org/wiki/Spina_bifida" title="Spina bifida – Simple English" lang="en-simple" hreflang="en-simple" data-title="Spina bifida" data-language-autonym="Simple English" data-language-local-name="Simple English" class="interlanguage-link-target">Simple English</a></li><li class="interlanguage-link interwiki-sl mw-list-item"><a href="https://sl.wikipedia.org/wiki/Spina_bifida" title="Spina bifida – Slovenian" lang="sl" hreflang="sl" data-title="Spina bifida" data-language-autonym="Slovenščina" data-language-local-name="Slovenian" class="interlanguage-link-target">Slovenščina</a></li><li class="interlanguage-link interwiki-sr mw-list-item"><a href="https://sr.wikipedia.org/wiki/%D0%A1%D0%BF%D0%B8%D0%BD%D0%B0_%D0%B1%D0%B8%D1%84%D0%B8%D0%B4%D0%B0" title="Спина бифида – Serbian" lang="sr" hreflang="sr" data-title="Спина бифида" data-language-autonym="Српски / srpski" data-language-local-name="Serbian" class="interlanguage-link-target">Српски / srpski</a></li><li class="interlanguage-link interwiki-fi mw-list-item"><a href="https://fi.wikipedia.org/wiki/Spina_bifida" title="Spina bifida – Finnish" lang="fi" hreflang="fi" data-title="Spina bifida" data-language-autonym="Suomi" data-language-local-name="Finnish" class="interlanguage-link-target">Suomi</a></li><li class="interlanguage-link interwiki-sv mw-list-item"><a href="https://sv.wikipedia.org/wiki/Ryggm%C3%A4rgsbr%C3%A5ck" title="Ryggmärgsbråck – Swedish" lang="sv" hreflang="sv" data-title="Ryggmärgsbråck" data-language-autonym="Svenska" data-language-local-name="Swedish" class="interlanguage-link-target">Svenska</a></li><li class="interlanguage-link interwiki-ta mw-list-item"><a href="https://ta.wikipedia.org/wiki/%E0%AE%AE%E0%AF%81%E0%AE%A4%E0%AF%81%E0%AE%95%E0%AF%81_%E0%AE%A8%E0%AE%BE%E0%AE%A3%E0%AF%8D_%E0%AE%AA%E0%AE%BF%E0%AE%B1%E0%AE%B5%E0%AE%BF_%E0%AE%95%E0%AF%81%E0%AE%B1%E0%AF%88%E0%AE%AA%E0%AE%BE%E0%AE%9F%E0%AF%81" title="முதுகு நாண் பிறவி குறைபாடு – Tamil" lang="ta" hreflang="ta" 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class="noprint">From Wikipedia, the free encyclopedia</div> </div> <div id="contentSub"><div id="mw-content-subtitle"></div></div> <div id="mw-content-text" class="mw-body-content"><div class="mw-content-ltr mw-parser-output" lang="en" dir="ltr"><div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Birth defect of the spinal cord</div> <div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Medical condition</div><style data-mw-deduplicate="TemplateStyles:r1257001546">.mw-parser-output .infobox-subbox{padding:0;border:none;margin:-3px;width:auto;min-width:100%;font-size:100%;clear:none;float:none;background-color:transparent}.mw-parser-output .infobox-3cols-child{margin:auto}.mw-parser-output .infobox .navbar{font-size:100%}@media screen{html.skin-theme-clientpref-night .mw-parser-output .infobox-full-data:not(.notheme)>div:not(.notheme)[style]{background:#1f1f23!important;color:#f8f9fa}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .infobox-full-data:not(.notheme) div:not(.notheme){background:#1f1f23!important;color:#f8f9fa}}@media(min-width:640px){body.skin--responsive .mw-parser-output .infobox-table{display:table!important}body.skin--responsive .mw-parser-output .infobox-table>caption{display:table-caption!important}body.skin--responsive .mw-parser-output .infobox-table>tbody{display:table-row-group}body.skin--responsive .mw-parser-output .infobox-table tr{display:table-row!important}body.skin--responsive .mw-parser-output .infobox-table th,body.skin--responsive .mw-parser-output .infobox-table td{padding-left:inherit;padding-right:inherit}}</style><table class="infobox ib-medical-condition"><tbody><tr><th colspan="2" class="infobox-above" style="background:#ccc">Spina bifida</th></tr><tr style="background-color: #f8f9fa;"><td colspan="2" class="infobox-full-data"><a href="/wiki/File:Spina-bifida.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/7/7e/Spina-bifida.jpg/220px-Spina-bifida.jpg" decoding="async" width="220" height="177" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/7/7e/Spina-bifida.jpg/330px-Spina-bifida.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/7/7e/Spina-bifida.jpg/440px-Spina-bifida.jpg 2x" data-file-width="1731" data-file-height="1396" /></a></td></tr><tr><td colspan="2" class="infobox-full-data">Illustration of a child with spina bifida</td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_specialty" title="Medical specialty">Specialty</a></th><td class="infobox-data"><a href="/wiki/Pediatrics" title="Pediatrics">Pediatrics</a>, <a href="/wiki/Neurosurgery" title="Neurosurgery">neurosurgery</a>, <a href="/wiki/Rehabilitation_medicine" class="mw-redirect" title="Rehabilitation medicine">rehabilitation medicine</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Signs_and_symptoms" title="Signs and symptoms">Symptoms</a></th><td class="infobox-data">Hairy patch, dimple, dark spot, swelling on the lower back<a href="#cite_note-NIH2012Over-1">[1]</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Complication_(medicine)" title="Complication (medicine)">Complications</a></th><td class="infobox-data">Poor ability to walk, problems with bladder or bowel control, <a href="/wiki/Hydrocephalus" title="Hydrocephalus">hydrocephalus</a>, <a href="/wiki/Tethered_spinal_cord" class="mw-redirect" title="Tethered spinal cord">tethered spinal cord</a>, <a href="/wiki/Latex_allergy" title="Latex allergy">latex allergy</a><a href="#cite_note-NIH2012Sym-2">[2]</a></td></tr><tr><th scope="row" class="infobox-label">Causes</th><td class="infobox-data">Genetic and environmental factors<a href="#cite_note-NIH2012Ca-3">[3]</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Risk_factor" title="Risk factor">Risk factors</a></th><td class="infobox-data">Lack of <a href="/wiki/Folate" title="Folate">folate</a> during <a href="/wiki/Pregnancy" title="Pregnancy">pregnancy</a>, certain antiseizure medications, obesity, poorly controlled <a href="/wiki/Diabetes_mellitus" class="mw-redirect" title="Diabetes mellitus">diabetes</a><a href="#cite_note-NIH2012Ca-3">[3]</a><a href="#cite_note-NIH2012Epi-4">[4]</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_diagnosis" title="Medical diagnosis">Diagnostic method</a></th><td class="infobox-data"><a href="/wiki/Amniocentesis" title="Amniocentesis">Amniocentesis</a>, <a href="/wiki/Medical_imaging" title="Medical imaging">medical imaging</a><a href="#cite_note-NIH2012Diag-5">[5]</a></td></tr><tr><th scope="row" class="infobox-label">Prevention</th><td class="infobox-data">Folate supplementation<a href="#cite_note-NIH2012Ca-3">[3]</a></td></tr><tr><th scope="row" class="infobox-label">Treatment</th><td class="infobox-data">Surgery<a href="#cite_note-NIH2012Tx-6">[6]</a></td></tr><tr><th scope="row" class="infobox-label">Frequency</th><td class="infobox-data">15% (occulta), 0.1–5 per 1000 births (others)<a href="#cite_note-ReferenceB-7">[7]</a><a href="#cite_note-NIH2017-8">[8]</a></td></tr></tbody></table> Spina bifida (SB; /ˌspaɪnə ˈbɪfɪdə/,<a href="#cite_note-9">[9]</a> Latin for 'split spine')<a href="#cite_note-ninds-10">[10]</a> is a <a href="/wiki/Birth_defect" title="Birth defect">birth defect</a> in which there is incomplete closing of the <a href="/wiki/Vertebral_column" title="Vertebral column">spine</a> and the <a href="/wiki/Meninges" title="Meninges">membranes</a> around the <a href="/wiki/Spinal_cord" title="Spinal cord">spinal cord</a> during <a href="/wiki/Embryonic_development" class="mw-redirect" title="Embryonic development">early development in pregnancy</a>.<a href="#cite_note-NIH2012Over-1">[1]</a> There are three main types: spina bifida occulta, meningocele and myelomeningocele.<a href="#cite_note-NIH2012Over-1">[1]</a> Meningocele and myelomeningocele may be grouped as spina bifida cystica.<a href="#cite_note-Fer2016-11">[11]</a> The most common location is the <a href="/wiki/Lumbar_vertebrae" title="Lumbar vertebrae">lower back</a>, but in rare cases it may be in the <a href="/wiki/Thoracic_vertebrae" title="Thoracic vertebrae">middle back</a> or <a href="/wiki/Cervical_vertebrae" title="Cervical vertebrae">neck</a>.<a href="#cite_note-12">[12]</a> Occulta has no or only mild signs, which may include a hairy patch, dimple, dark spot or swelling on the back at the site of the gap in the spine.<a href="#cite_note-NIH2012Diag-5">[5]</a><a href="#cite_note-NIH2012Over-1">[1]</a> Meningocele typically causes mild problems, with a sac of fluid present at the gap in the spine.<a href="#cite_note-NIH2012Over-1">[1]</a> Myelomeningocele, also known as open spina bifida, is the most severe form.<a href="#cite_note-NIH2012Sym-2">[2]</a> Problems associated with this form include poor ability to walk, impaired <a href="/wiki/Neurogenic_bladder_dysfunction" title="Neurogenic bladder dysfunction">bladder</a> or <a href="/wiki/Neurogenic_bowel_dysfunction" title="Neurogenic bowel dysfunction">bowel control</a>, <a href="/wiki/Hydrocephalus" title="Hydrocephalus">accumulation of fluid in the brain</a>, a <a href="/wiki/Tethered_spinal_cord" class="mw-redirect" title="Tethered spinal cord">tethered spinal cord</a> and <a href="/wiki/Latex_allergy" title="Latex allergy">latex allergy</a>.<a href="#cite_note-NIH2012Sym-2">[2]</a> Some experts believe such an allergy can be caused by frequent exposure to latex, which is common for people with spina bifida who have shunts and have had many surgeries. Learning problems are relatively uncommon.<a href="#cite_note-NIH2012Sym-2">[2]</a> Spina bifida is believed to be due to a combination of genetic and environmental factors.<a href="#cite_note-NIH2012Ca-3">[3]</a> After having one child with the condition, or if one of the parents has the condition, there is a 4% chance that the next child will also be affected.<a href="#cite_note-NIH2012Epi-4">[4]</a> <a href="/wiki/Folate_deficiency" title="Folate deficiency">Not having enough folate</a> (<a href="/wiki/Folate" title="Folate">vitamin B9</a>) in the diet before and during <a href="/wiki/Pregnancy" title="Pregnancy">pregnancy</a> also plays a significant role.<a href="#cite_note-NIH2012Ca-3">[3]</a> Other risk factors include certain <a href="/wiki/Antiseizure_medications" class="mw-redirect" title="Antiseizure medications">antiseizure medications</a>, <a href="/wiki/Obesity" title="Obesity">obesity</a> and poorly controlled <a href="/wiki/Diabetes" title="Diabetes">diabetes</a>.<a href="#cite_note-NIH2012Epi-4">[4]</a> Diagnosis may occur either before or after a child is born.<a href="#cite_note-NIH2012Diag-5">[5]</a> Before birth, if a blood test or <a href="/wiki/Amniocentesis" title="Amniocentesis">amniocentesis</a> finds a high level of <a href="/wiki/Alpha-fetoprotein" title="Alpha-fetoprotein">alpha-fetoprotein</a> (AFP), there is a higher risk of spina bifida.<a href="#cite_note-NIH2012Diag-5">[5]</a> <a href="/wiki/Medical_ultrasound" title="Medical ultrasound">Ultrasound</a> examination may also detect the problem. <a href="/wiki/Medical_imaging" title="Medical imaging">Medical imaging</a> can confirm the diagnosis after birth.<a href="#cite_note-NIH2012Diag-5">[5]</a> Spina bifida is a type of <a href="/wiki/Neural_tube_defect" title="Neural tube defect">neural tube defect</a> related to but distinct from other types such as <a href="/wiki/Anencephaly" title="Anencephaly">anencephaly</a> and <a href="/wiki/Encephalocele" title="Encephalocele">encephalocele</a>.<a href="#cite_note-NICHD2015-13">[13]</a> Most cases of spina bifida can be prevented if the mother gets enough folate before and during pregnancy.<a href="#cite_note-NIH2012Ca-3">[3]</a> Adding folic acid to <a href="/wiki/Flour" title="Flour">flour</a> has been found to be effective for most women.<a href="#cite_note-14">[14]</a> Open spina bifida can be surgically closed before or after birth.<a href="#cite_note-NIH2012Tx-6">[6]</a> A <a href="/wiki/Cerebral_shunt" title="Cerebral shunt">shunt</a> may be needed in those with hydrocephalus, and a tethered spinal cord may be surgically repaired.<a href="#cite_note-NIH2012Tx-6">[6]</a> Devices to help with movement such as crutches or wheelchairs may be useful.<a href="#cite_note-NIH2012Tx-6">[6]</a> <a href="/wiki/Urinary_catheterization" title="Urinary catheterization">Urinary catheterization</a> may also be needed.<a href="#cite_note-NIH2012Tx-6">[6]</a> Rates of other types of spina bifida vary significantly by country, from 0.1 to 5 per 1,000 <a href="/wiki/Birth" title="Birth">births</a>.<a href="#cite_note-Springer-15">[15]</a> On average, in <a href="/wiki/Developed_countries" class="mw-redirect" title="Developed countries">developed countries</a>, including the United States, it occurs in about 0.4 per 1,000 births.<a href="#cite_note-ReferenceB-7">[7]</a><a href="#cite_note-NIH2012Epi-4">[4]</a><a href="#cite_note-16">[16]</a> In India, it affects about 1.9 per 1,000 births.<a href="#cite_note-ReferenceC-17">[17]</a> <a href="/wiki/Europeans" class="mw-redirect" title="Europeans">Europeans</a> are at higher risk compared to <a href="/wiki/Africans" class="mw-redirect" title="Africans">Africans</a>.<a href="#cite_note-Newborn_surgery-18">[18]</a> <style data-mw-deduplicate="TemplateStyles:r886046785">.mw-parser-output .toclimit-2 .toclevel-1 ul,.mw-parser-output .toclimit-3 .toclevel-2 ul,.mw-parser-output .toclimit-4 .toclevel-3 ul,.mw-parser-output .toclimit-5 .toclevel-4 ul,.mw-parser-output .toclimit-6 .toclevel-5 ul,.mw-parser-output .toclimit-7 .toclevel-6 ul{display:none}</style><div class="toclimit-3"><meta property="mw:PageProp/toc" /></div> <div class="mw-heading mw-heading2"><h2 id="Types">Types</h2>[<a href="/w/index.php?title=Spina_bifida&action=edit&section=1" title="Edit section: Types">edit</a>]</div> <figure class="mw-halign-right" typeof="mw:File/Thumb"><a href="/wiki/File:Typesofspinabifida.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/a/a3/Typesofspinabifida.jpg" decoding="async" width="500" height="254" class="mw-file-element" data-file-width="500" data-file-height="254" /></a><figcaption>Different types of spina bifida</figcaption></figure> <div class="mw-heading mw-heading3"><h3 id="Spina_bifida_occulta">Spina bifida occulta</h3>[<a href="/w/index.php?title=Spina_bifida&action=edit&section=2" title="Edit section: Spina bifida occulta">edit</a>]</div> Occulta is <a href="/wiki/Latin" title="Latin">Latin</a> for 'hidden'. This is the mildest form of spina bifida.<a href="#cite_note-19">[19]</a> In occulta, the outer part of some of the vertebrae is not completely closed.<a href="#cite_note-emedicine-20">[20]</a> The splits in the vertebrae are so small that the spinal cord does not protrude. The skin at the site of the <a href="/wiki/Lesion" title="Lesion">lesion</a> may be normal, or it may have some hair growing from it; there may be a dimple in the skin, or a <a href="/wiki/Birthmark" title="Birthmark">birthmark</a>.<a href="#cite_note-SBASBO-21">[21]</a> Unlike most other types of neural tube defects, spina bifida occulta is not associated with increased <a href="/wiki/Alpha-fetoprotein" title="Alpha-fetoprotein">AFP</a>, a common screening tool used to detect neural tube defects in utero. This is because, unlike in most of the other neural tube defects, the dural lining is maintained.<a href="#cite_note-22">[22]</a> Many people with this type of spina bifida do not even know they have it, as the condition is asymptomatic in most cases.<a href="#cite_note-SBASBO-21">[21]</a> A systematic review of <a href="/wiki/Radiography" title="Radiography">radiographic</a> research studies found no relationship between spina bifida occulta and back pain.<a href="#cite_note-pmid9055372-23">[23]</a> More recent studies not included in the review support the negative findings.<a href="#cite_note-pmid15885037-24">[24]</a><a href="#cite_note-pmid15090397-25">[25]</a><a href="#cite_note-pmid14654032-26">[26]</a> However other studies suggest spina bifida occulta is not always harmless. One study found that among patients with back pain severity is worse if spina bifida occulta is present.<a href="#cite_note-pmid15834319-27">[27]</a><a href="#cite_note-pmid8153797-28">[28]</a> Incomplete posterior fusion is not a true spina bifida and is very rarely of neurological significance.<a href="#cite_note-29">[29]</a> <div class="mw-heading mw-heading3"><h3 id="Meningocele">Meningocele</h3>[<a href="/w/index.php?title=Spina_bifida&action=edit&section=3" title="Edit section: Meningocele">edit</a>]</div> A posterior meningocele (<a href="/wiki/Help:IPA/English" title="Help:IPA/English">/mɪˈnɪŋɡəˌsiːl/</a>) or meningeal cyst (<a href="/wiki/Help:IPA/English" title="Help:IPA/English">/mɪˈnɪndʒiəl/</a>) is the least common form of spina bifida. In this form, a single developmental defect allows the <a href="/wiki/Meninges" title="Meninges">meninges</a> to herniate between the vertebrae. As the nervous system remains undamaged, individuals with meningocele are unlikely to have long-term health problems, although cases of <a href="/wiki/Tethered_spinal_cord_syndrome" title="Tethered spinal cord syndrome">tethered cord</a> have been reported. Causes of meningocele include <a href="/wiki/Teratoma" title="Teratoma">teratoma</a> and other <a href="/wiki/Tumor" class="mw-redirect" title="Tumor">tumors</a> of the <a href="/wiki/Sacrococcygeal_teratoma" title="Sacrococcygeal teratoma">sacrococcyx</a> and of the <a href="/wiki/Presacral_space" title="Presacral space">presacral space</a>, and <a href="/wiki/Currarino_syndrome" title="Currarino syndrome">Currarino syndrome</a>.[<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>] A meningocele may also form through dehiscences in the base of the skull. These may be classified by their localisation as occipital, frontoethmoidal or nasal. Endonasal meningoceles lie at the roof of the <a href="/wiki/Nasal_cavity" title="Nasal cavity">nasal cavity</a> and may be mistaken for a <a href="/wiki/Nasal_polyp" title="Nasal polyp">nasal polyp</a>. They are treated surgically. Encephalomeningoceles are classified in the same way and also contain brain tissue.[<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>] <div class="mw-heading mw-heading3"><h3 id="Myelomeningocele">Myelomeningocele</h3>[<a href="/w/index.php?title=Spina_bifida&action=edit&section=4" title="Edit section: Myelomeningocele">edit</a>]</div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:PMC5193124_eplasty16ic51_fig1.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/7/7d/PMC5193124_eplasty16ic51_fig1.png/310px-PMC5193124_eplasty16ic51_fig1.png" decoding="async" width="310" height="116" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/7/7d/PMC5193124_eplasty16ic51_fig1.png/465px-PMC5193124_eplasty16ic51_fig1.png 1.5x, //upload.wikimedia.org/wikipedia/commons/7/7d/PMC5193124_eplasty16ic51_fig1.png 2x" data-file-width="474" data-file-height="177" /></a><figcaption>A lumbar myelomeningocele</figcaption></figure> Myelomeningocele (MMC), also known as meningomyelocele, is the type of spina bifida that often results in the most severe complications and affects the meninges and nerves.<a href="#cite_note-NIH-30">[30]</a> In individuals with myelomeningocele, the unfused portion of the spinal column allows the spinal cord to protrude through an opening. Myelomeningocele occurs in the third week of embryonic development, during neural tube pore closure. MMC is a failure of this to occur completely.<a href="#cite_note-NIH2012Ca-3">[3]</a> The meningeal membranes that cover the spinal cord also protrude through the opening, forming a sac enclosing the spinal elements, such as meninges, cerebrospinal fluid, and parts of the spinal cord and nerve roots.<a href="#cite_note-31">[31]</a> Myelomeningocele is also associated with club foot deformity, and <a href="/wiki/Arnold%E2%80%93Chiari_malformation" class="mw-redirect" title="Arnold–Chiari malformation">Arnold–Chiari malformation</a>, necessitating a VP shunt placement.<a href="#cite_note-32">[32]</a><a href="#cite_note-NICHD2015-13">[13]</a> Toxins and conditions associated with MMC formation include: <a href="/wiki/Calcium-channel_blockers" class="mw-redirect" title="Calcium-channel blockers">calcium-channel blockers</a>, <a href="/wiki/Carbamazepine" title="Carbamazepine">carbamazepine</a>, <a href="/wiki/Cytochalasins" class="mw-redirect" title="Cytochalasins">cytochalasins</a>, <a href="/wiki/Hyperthermia" title="Hyperthermia">hyperthermia</a>, and <a href="/wiki/Valproic_acid" class="mw-redirect" title="Valproic acid">valproic acid</a>.<a href="#cite_note-Springer-15">[15]</a> <div class="mw-heading mw-heading4"><h4 id="Myelocele">Myelocele</h4>[<a href="/w/index.php?title=Spina_bifida&action=edit&section=5" title="Edit section: Myelocele">edit</a>]</div> Spina bifida with myelocele is the most severe form of myelomeningocele. In this type, the involved area is represented by a flattened, plate-like mass of nervous tissue with no overlying membrane. The exposure of these nerves and tissues make the baby more prone to life-threatening infections such as <a href="/wiki/Meningitis" title="Meningitis">meningitis</a>.<a href="#cite_note-33">[33]</a> The protruding portion of the spinal cord and the nerves that originate at that level of the cord are damaged or not properly developed. As a result, there is usually some degree of <a href="/wiki/Paralysis" title="Paralysis">paralysis</a> and loss of sensation below the level of the spinal cord defect. Thus, the more cranial the level of the defect, the more severe the associated nerve dysfunction and resultant paralysis may be. Symptoms may include ambulatory problems, loss of sensation, deformities of the hips, knees or feet, and loss of muscle tone.[<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>] <ul class="gallery mw-gallery-traditional"> <li class="gallerybox" style="width: 155px"> <div class="thumb" style="width: 150px; height: 150px;"><a href="/wiki/File:Spina_Bifida_pelvis_X-ray.jpg" class="mw-file-description" title="X-ray image of spina bifida occulta in S-1"><img alt="X-ray image of spina bifida occulta in S-1" src="//upload.wikimedia.org/wikipedia/commons/thumb/6/67/Spina_Bifida_pelvis_X-ray.jpg/120px-Spina_Bifida_pelvis_X-ray.jpg" decoding="async" width="120" height="90" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/6/67/Spina_Bifida_pelvis_X-ray.jpg/180px-Spina_Bifida_pelvis_X-ray.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/6/67/Spina_Bifida_pelvis_X-ray.jpg/240px-Spina_Bifida_pelvis_X-ray.jpg 2x" data-file-width="500" data-file-height="375" /></a></div> <div class="gallerytext">X-ray image of spina bifida occulta in S-1</div> </li> <li class="gallerybox" style="width: 155px"> <div class="thumb" style="width: 150px; height: 150px;"><a href="/wiki/File:Atlasbogenspalt.jpg" class="mw-file-description" title="X-ray computed tomography scan of unfused arch at C1"><img alt="X-ray computed tomography scan of unfused arch at C1" src="//upload.wikimedia.org/wikipedia/commons/thumb/e/ed/Atlasbogenspalt.jpg/120px-Atlasbogenspalt.jpg" decoding="async" width="120" height="108" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/e/ed/Atlasbogenspalt.jpg/180px-Atlasbogenspalt.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/e/ed/Atlasbogenspalt.jpg/240px-Atlasbogenspalt.jpg 2x" data-file-width="1142" data-file-height="1031" /></a></div> <div class="gallerytext"><a href="/wiki/X-ray_computed_tomography" class="mw-redirect" title="X-ray computed tomography">X-ray computed tomography</a> scan of unfused arch at C1</div> </li> <li class="gallerybox" style="width: 155px"> <div class="thumb" style="width: 150px; height: 150px;"><a href="/wiki/File:Meningomyelocele_diagram.jpg" class="mw-file-description" title="Myelomeningocele in the lumbar area (1) External sac with cerebrospinal fluid (2) Spinal cord wedged between the vertebrae"><img alt="Myelomeningocele in the lumbar area (1) External sac with cerebrospinal fluid (2) Spinal cord wedged between the vertebrae" src="//upload.wikimedia.org/wikipedia/commons/thumb/1/13/Meningomyelocele_diagram.jpg/107px-Meningomyelocele_diagram.jpg" decoding="async" width="107" height="120" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/1/13/Meningomyelocele_diagram.jpg/161px-Meningomyelocele_diagram.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/1/13/Meningomyelocele_diagram.jpg/215px-Meningomyelocele_diagram.jpg 2x" data-file-width="300" data-file-height="335" /></a></div> <div class="gallerytext">Myelomeningocele in the lumbar area (1) External sac with <a href="/wiki/Cerebrospinal_fluid" title="Cerebrospinal fluid">cerebrospinal fluid</a> (2) Spinal cord wedged between the vertebrae</div> </li> </ul> <div class="mw-heading mw-heading2"><h2 id="Signs_and_symptoms">Signs and symptoms</h2>[<a href="/w/index.php?title=Spina_bifida&action=edit&section=6" title="Edit section: Signs and symptoms">edit</a>]</div> <div class="mw-heading mw-heading3"><h3 id="Physical_problems">Physical problems</h3>[<a href="/w/index.php?title=Spina_bifida&action=edit&section=7" title="Edit section: Physical problems">edit</a>]</div> Physical signs of spina bifida may include: <ul><li>Leg weakness and paralysis<a href="#cite_note-Mitchell-34">[34]</a></li> <li>Orthopedic abnormalities (i.e., <a href="/wiki/Club_foot" class="mw-redirect" title="Club foot">club foot</a>, <a href="/wiki/Dislocation_of_hip" class="mw-redirect" title="Dislocation of hip">hip dislocation</a>, <a href="/wiki/Scoliosis" title="Scoliosis">scoliosis</a>)<a href="#cite_note-Mitchell-34">[34]</a></li> <li>Bladder and bowel control problems, including incontinence, <a href="/wiki/Urinary_tract_infections" class="mw-redirect" title="Urinary tract infections">urinary tract infections</a>, and poor kidney function<a href="#cite_note-Mitchell-34">[34]</a></li> <li><a href="/wiki/Bedsore" class="mw-redirect" title="Bedsore">Pressure sores</a> and skin irritations<a href="#cite_note-Mitchell-34">[34]</a></li> <li>Abnormal eye movement<a href="#cite_note-Juranek_&_Salman-35">[35]</a></li></ul> 68% of children with spina bifida have an <a href="/wiki/Allergy" title="Allergy">allergy</a> to <a href="/wiki/Latex" title="Latex">latex</a>,<a href="#cite_note-36">[36]</a> ranging from mild to life-threatening. The common use of latex in medical facilities makes this a particularly serious concern. The most common approach to avoid developing an allergy is to avoid contact with latex-containing products such as examination gloves and <a href="/wiki/Catheters" class="mw-redirect" title="Catheters">catheters</a> that do not specify they are latex-free, and many other products, such as some commonly used by dentists.<a href="#cite_note-emedicine-20">[20]</a> The spinal cord lesion or the scarring due to surgery may result in a <a href="/wiki/Tethered_spinal_cord_syndrome" title="Tethered spinal cord syndrome">tethered spinal cord</a>. In some individuals, this causes significant traction and stress on the spinal cord and can lead to a worsening of associated paralysis, <a href="/wiki/Scoliosis" title="Scoliosis">scoliosis</a>, back pain, and worsening bowel and/or bladder function.<a href="#cite_note-37">[37]</a> <div class="mw-heading mw-heading3"><h3 id="Neurological_problems">Neurological problems</h3>[<a href="/w/index.php?title=Spina_bifida&action=edit&section=8" title="Edit section: Neurological problems">edit</a>]</div> Many individuals with spina bifida have an associated abnormality of the <a href="/wiki/Cerebellum" title="Cerebellum">cerebellum</a>, called the <a href="/wiki/Arnold_Chiari_II_malformation" class="mw-redirect" title="Arnold Chiari II malformation">Arnold Chiari II malformation</a>. In affected individuals, the back portion of the brain is displaced from the back of the skull down into the upper neck. In about 90% of the people with myelomeningocele, <a href="/wiki/Hydrocephalus" title="Hydrocephalus">hydrocephalus</a> also occurs because the displaced cerebellum interferes with the normal flow of <a href="/wiki/Cerebrospinal_fluid" title="Cerebrospinal fluid">cerebrospinal fluid</a>, causing an excess of the fluid to accumulate.<a href="#cite_note-NINDS-38">[38]</a> In fact, the cerebellum also tends to be smaller in individuals with spina bifida, especially for those with higher lesion levels.<a href="#cite_note-Juranek_&_Salman-35">[35]</a> The <a href="/wiki/Corpus_callosum" title="Corpus callosum">corpus callosum</a> is abnormally developed in 70–90% of individuals with spina bifida myelomeningocele; this affects the communication processes between the left and right brain hemispheres.<a href="#cite_note-Barkovich_2005-39">[39]</a> Further, <a href="/wiki/White_matter" title="White matter">white matter</a> tracts connecting posterior brain regions with anterior regions appear less organized. White matter tracts between frontal regions have also been found to be impaired.<a href="#cite_note-Juranek_&_Salman-35">[35]</a> <a href="/wiki/Cerebral_cortex" title="Cerebral cortex">Cortex</a> abnormalities may also be present. For example, <a href="/wiki/Frontal_lobe" title="Frontal lobe">frontal regions</a> of the brain tend to be thicker than expected, while posterior and parietal regions are thinner. Thinner sections of the brain are also associated with increased cortical folding.<a href="#cite_note-Juranek_&_Salman-35">[35]</a> Neurons within the cortex may also be displaced.<a href="#cite_note-Wills-40">[40]</a> <div class="mw-heading mw-heading4"><h4 id="Executive_function">Executive function</h4>[<a href="/w/index.php?title=Spina_bifida&action=edit&section=9" title="Edit section: Executive function">edit</a>]</div> Several studies have demonstrated difficulties with <a href="/wiki/Executive_functions" title="Executive functions">executive functions</a> in youth with spina bifida,<a href="#cite_note-Burmeister-41">[41]</a><a href="#cite_note-Tarazi_2008-42">[42]</a> with greater deficits observed in youth with shunted hydrocephalus.<a href="#cite_note-Fletcher_et_al_1996-43">[43]</a> Unlike typically developing children, youths with spina bifida do not tend to improve in their executive functioning as they grow older.<a href="#cite_note-Tarazi_2008-42">[42]</a> Specific areas of difficulty in some individuals include planning, organizing, initiating, and <a href="/wiki/Working_memory" title="Working memory">working memory</a>. Problem-solving, <a href="/wiki/Abstraction" title="Abstraction">abstraction</a>, and visual planning may also be impaired.<a href="#cite_note-Snow_1999-44">[44]</a> Further, children with spina bifida may have poor <a href="/wiki/Cognitive_flexibility" title="Cognitive flexibility">cognitive flexibility</a>. Although executive functions are often attributed to the <a href="/wiki/Frontal_lobe" title="Frontal lobe">frontal lobes</a> of the brain, individuals with spina bifida have intact frontal lobes; therefore, other areas of the brain may be implicated.<a href="#cite_note-Fletcher_et_al_1996-43">[43]</a> Individuals with spina bifida, especially those with shunted hydrocephalus, often have attention problems. Children with spina bifida and shunted hydrocephalus have higher rates of <a href="/wiki/Attention_deficit_hyperactivity_disorder" title="Attention deficit hyperactivity disorder">ADHD</a> than children without those conditions (31% vs. 17%).<a href="#cite_note-Burmeister-41">[41]</a> Deficits have been observed for selective attention and focused attention, although poor motor speed may contribute to poor scores on tests of attention.<a href="#cite_note-Fletcher_et_al_1996-43">[43]</a><a href="#cite_note-Rose_Holmbeck-45">[45]</a> Attention deficits may be evident at a very early age, as <a href="/wiki/Infant" title="Infant">infants</a> with spina bifida lag behind their peers in orienting to faces.<a href="#cite_note-Landry_et_al-46">[46]</a> <div class="mw-heading mw-heading4"><h4 id="Academic_skills">Academic skills</h4>[<a href="/w/index.php?title=Spina_bifida&action=edit&section=10" title="Edit section: Academic skills">edit</a>]</div> Individuals with spina bifida may struggle academically, especially in the subjects of <a href="/wiki/Mathematics" title="Mathematics">mathematics</a> and <a href="/wiki/Reading_(process)" class="mw-redirect" title="Reading (process)">reading</a>. In one study, 60% of children with spina bifida were diagnosed with a learning disability.<a href="#cite_note-Mayes_Calhoun-47">[47]</a> In addition to brain abnormalities directly related to various academic skills, achievement is likely affected by impaired attentional control and executive functioning.<a href="#cite_note-Wills-40">[40]</a> Children with spina bifida may perform well in elementary school, but begin to struggle as academic demands increase.[<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>] Children with spina bifida are more likely than their peers without spina bifida to be <a href="/wiki/Dyscalculia" title="Dyscalculia">dyscalculic</a>.<a href="#cite_note-Barnes_et_al.,_2006-48">[48]</a> Individuals with spina bifida have demonstrated stable difficulties with arithmetic accuracy and speed, mathematical problem-solving, and general use and understanding of numbers in everyday life.<a href="#cite_note-Dennis_2002-49">[49]</a> Mathematics difficulties may be directly related to the thinning of the <a href="/wiki/Parietal_lobe" title="Parietal lobe">parietal lobes</a> (regions implicated in mathematical functioning) and indirectly associated with deformities of the <a href="/wiki/Cerebellum" title="Cerebellum">cerebellum</a> and <a href="/wiki/Midbrain" title="Midbrain">midbrain</a> that affect other functions involved in mathematical skills. Further, higher numbers of shunt revisions are associated with poorer mathematics abilities.<a href="#cite_note-Hetherington_2006-50">[50]</a> <a href="/wiki/Working_memory" title="Working memory">Working memory</a> and inhibitory control deficiencies have been implicated for math difficulties,<a href="#cite_note-English-51">[51]</a> although visual-spatial difficulties are not likely involved.<a href="#cite_note-Barnes_et_al.,_2006-48">[48]</a> Early intervention to address mathematics difficulties and associated executive functions is crucial.<a href="#cite_note-English-51">[51]</a> Individuals with spina bifida tend to have better reading skills than mathematics skills.<a href="#cite_note-Hetherington_2006-50">[50]</a> Children and adults with spina bifida have stronger abilities in reading accuracy than in reading comprehension.<a href="#cite_note-Barnes_et_al_2004-52">[52]</a> Comprehension may be especially impaired for text that requires an abstract synthesis of information rather than a more literal understanding.<a href="#cite_note-Fletcher_et_al_2004-53">[53]</a> Individuals with spina bifida may have difficulty with writing due to deficits in fine motor control and working memory.<a href="#cite_note-Barnes_et_al_2004-52">[52]</a> <div class="mw-heading mw-heading2"><h2 id="Cause">Cause</h2>[<a href="/w/index.php?title=Spina_bifida&action=edit&section=11" title="Edit section: Cause">edit</a>]</div> Spina bifida is believed to be caused by a combination of genetic and environmental factors.<a href="#cite_note-NIH2012Ca-3">[3]</a> The genetic component is estimated at 60–70%, but few causative genes have been identified, despite much information gathered from mouse models.<a href="#cite_note-54">[54]</a> After having one child with the condition, or if a parent has the condition, there is a 4% chance the next child will also be affected.<a href="#cite_note-NIH2012Epi-4">[4]</a> A <a href="/wiki/Folic_acid" class="mw-redirect" title="Folic acid">folic acid</a> deficiency during pregnancy also plays a significant role.<a href="#cite_note-NIH2012Ca-3">[3]</a> Other risk factors include certain antiseizure medications, obesity, and poorly managed <a href="/wiki/Diabetes_mellitus" class="mw-redirect" title="Diabetes mellitus">diabetes</a>.<a href="#cite_note-NIH2012Epi-4">[4]</a> Alcohol misuse can trigger <a href="/wiki/Macrocytosis" title="Macrocytosis">macrocytosis</a> which discards <a href="/wiki/Folic_acid" class="mw-redirect" title="Folic acid">folate</a>. After stopping the drinking of <a href="/wiki/Alcohol_(drug)" title="Alcohol (drug)">alcohol</a>, a time period of months is needed to rejuvenate <a href="/wiki/Bone_marrow" title="Bone marrow">bone marrow</a> and recover from the macrocytosis.<a href="#cite_note-55">[55]</a> Certain mutations in the gene VANGL1 have been linked with spina bifida in some families with a history of the condition.<a href="#cite_note-pmid17409324-56">[56]</a> <div class="mw-heading mw-heading2"><h2 id="Pathophysiology">Pathophysiology</h2>[<a href="/w/index.php?title=Spina_bifida&action=edit&section=12" title="Edit section: Pathophysiology">edit</a>]</div> Spina bifida occurs when local regions of the neural tube fail to fuse or there is failure in formation of the vertebral neural arches. Neural arch formation occurs in the first month of <a href="/wiki/Embryo" title="Embryo">embryonic</a> development (often before the mother knows she is pregnant). Some forms are known to occur with primary conditions that cause raised central nervous system pressure, raising the possibility of a dual pathogenesis.<a href="#cite_note-57">[57]</a> In normal circumstances, the closure of the neural tube occurs around the 23rd (rostral closure) and 27th (caudal closure) day after <a href="/wiki/Fertilization" class="mw-redirect" title="Fertilization">fertilization</a>.<a href="#cite_note-paediatrics-58">[58]</a> However, if something interferes and the tube fails to close properly, a neural tube defect will occur. Maternal <a href="/wiki/Diabetes" title="Diabetes">diabetes</a>, <a href="/wiki/Anti-seizure_medication" class="mw-redirect" title="Anti-seizure medication">anti-seizure medication</a> use, obesity are known risk factors for the development of spina bifida.<a href="#cite_note-Iskandar_2022-59">[59]</a> Extensive evidence from mouse strains with spina bifida indicates that there is sometimes a genetic basis for the condition. Human spina bifida likely results from the interaction of multiple <a href="/wiki/Gene" title="Gene">genes</a> and environmental factors.[<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>] Research has shown the lack of <a href="/wiki/Folic_acid" class="mw-redirect" title="Folic acid">folic acid</a> (folate) is a contributing factor in the pathogenesis of neural tube defects, including spina bifida. Supplementation of the mother's diet with folate can reduce the incidence of neural tube defects by about 70%, and can also decrease the severity of these defects when they occur.<a href="#cite_note-60">[60]</a><a href="#cite_note-61">[61]</a><a href="#cite_note-62">[62]</a> It is unknown how or why folic acid has this effect.[<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>] Spina bifida does not follow direct patterns of <a href="/wiki/Heredity" title="Heredity">heredity</a> as do <a href="/wiki/Muscular_dystrophy" title="Muscular dystrophy">muscular dystrophy</a> or <a href="/wiki/Haemophilia" title="Haemophilia">haemophilia</a>. Studies show a woman having had one child with a neural tube defect such as spina bifida has about a 3% risk of having another affected child. This risk can be reduced with folic acid supplementation before pregnancy. <div class="mw-heading mw-heading2"><h2 id="Prevention">Prevention</h2>[<a href="/w/index.php?title=Spina_bifida&action=edit&section=13" title="Edit section: Prevention">edit</a>]</div> There is neither a single cause of spina bifida nor any known way to prevent it entirely. However, dietary supplementation with <a href="/wiki/Folic_acid" class="mw-redirect" title="Folic acid">folic acid</a> has been shown to be helpful in reducing the incidence of spina bifida. Folate supplementation prior to conception has been found to reduce the risk of neural tube defects, including spina bifida, by 70%.<a href="#cite_note-Iskandar_2022-59">[59]</a> Sources of folic acid include <a href="/wiki/Whole_grain" title="Whole grain">whole grains</a>, fortified <a href="/wiki/Breakfast_cereal" title="Breakfast cereal">breakfast cereals</a>, dried <a href="/wiki/Bean" title="Bean">beans</a>, <a href="/wiki/Leaf_vegetable" title="Leaf vegetable">leaf vegetables</a> and <a href="/wiki/Fruit" title="Fruit">fruits</a>.<a href="#cite_note-63">[63]</a> However it is difficult for women to get the recommended 400 micrograms of folic acid a day from unfortified foods.<a href="#cite_note-64">[64]</a> Globally, fortified wheat flour and other cereal grains are credited with preventing 50,000–61,000 neural tube birth defects such as spina bifida yearly, which is estimated to be 22% of total possible preventable neural tube defects assuming universal and worldwide folic acid fortification. Many countries in Africa, Asia, and Europe have yet to implement fortification <a href="#cite_note-65">[65]</a><a href="#cite_note-66">[66]</a> Folate fortification of enriched grain products has been mandatory in the United States since 1998. This prevents an estimated 600 to 700 incidents of spina bifida a year in the U.S. and saves $400–600 million in healthcare expenses.<a href="#cite_note-67">[67]</a> The <a href="/wiki/U.S._Food_and_Drug_Administration" class="mw-redirect" title="U.S. Food and Drug Administration">U.S. Food and Drug Administration</a>, <a href="/wiki/Public_Health_Agency_of_Canada" title="Public Health Agency of Canada">Public Health Agency of Canada</a><a href="#cite_note-68">[68]</a> and the UK Department of Health and Social Care (DHSC) recommended amount of folic acid for women of childbearing age and women planning to become pregnant is at least 0.4 mg/day of folic acid from at least three months before <a href="/wiki/Conception_(biology)" class="mw-redirect" title="Conception (biology)">conception</a>, and continued for the first 12 weeks of pregnancy.<a href="#cite_note-NHSdirect-69">[69]</a> The <a href="/wiki/United_States_Preventive_Services_Task_Force" title="United States Preventive Services Task Force">United States Preventive Services Task Force</a> (USPSTF) recommends all people who may become pregnant or are attempting pregnancy take a folic acid supplement containing 0.4–0.8 mg (400–800 mcg) of folic acid daily.<a href="#cite_note-USPSTF-70">[70]</a> Women who have already had a baby with spina bifida or other type of neural tube defect, or are taking <a href="/wiki/Anticonvulsant" title="Anticonvulsant">anticonvulsant</a> medication, should take a higher dose of 4–5 mg/day.<a href="#cite_note-NHSdirect-69">[69]</a> However, the daily requirement of folate and the recommended folate blood levels to prevent neural tube defects are not well established.<a href="#cite_note-Iskandar_2022-59">[59]</a> <div class="mw-heading mw-heading2"><h2 id="Screening">Screening</h2>[<a href="/w/index.php?title=Spina_bifida&action=edit&section=14" title="Edit section: Screening">edit</a>]</div> Tests are not 100% perfect, so even though screening results present negative, there is still a slight chance that spina bifida is present.<a href="#cite_note-71">[71]</a> Spina bifida can usually be detected during the second trimester of pregnancy by fetal <a href="/wiki/Ultrasound" title="Ultrasound">ultrasound</a>.<a href="#cite_note-Iskandar_2022-59">[59]</a> Increased levels of maternal serum alpha-fetoprotein (MSAFP) should be followed up by two tests – an <a href="/wiki/Ultrasound" title="Ultrasound">ultrasound</a> of the fetal spine and <a href="/wiki/Amniocentesis" title="Amniocentesis">amniocentesis</a> of the mother's amniotic fluid (to test for <a href="/wiki/Alpha-fetoprotein" title="Alpha-fetoprotein">alpha-fetoprotein</a> and <a href="/wiki/Acetylcholinesterase" title="Acetylcholinesterase">acetylcholinesterase</a>). AFP tests are now mandated by some state laws (including <a href="/wiki/California" title="California">California</a>) and failure to provide them can have legal ramifications. Spina bifida may be associated with other malformations as in dysmorphic syndromes, often resulting in spontaneous <a href="/wiki/Miscarriage" title="Miscarriage">miscarriage</a>. In the majority of cases, though, spina bifida is an isolated malformation.[<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>] Risks of amniocentesis, which may occur in approximately 1 in 900 tests, include leaking amniotic fluid, though this generally has no effect on pregnancy. However, second-trimester amniocentesis carries a slight risk of miscarriage of 0.1% to 0.3% when done by a skilled person using ultrasound, though research suggests that the risk of miscarriage is higher for amniocentesis done before 15 weeks of pregnancy. Infection transmission may occur from mother to child if the mother has infections such as hepatitis C, toxoplasmosis, or HIV/AIDS, or Rh sensitization, which ultimately damages the fetus' red blood cells. Needle injury to the fetus may occur, though serious injury is very rare, along with triggering a uterine infection, which is also very rare.<a href="#cite_note-72">[72]</a> <a href="/wiki/Genetic_counseling" title="Genetic counseling">Genetic counseling</a> and further <a href="/wiki/Genetic_testing" title="Genetic testing">genetic testing</a> through amniocentesis may be offered during the pregnancy, as some neural tube defects are associated with genetic disorders such as <a href="/wiki/Trisomy_18" title="Trisomy 18">trisomy 18</a>. Ultrasound screening for spina bifida is partly responsible for the decline in new cases, because many pregnancies are <a href="/wiki/Abortion" title="Abortion">terminated</a> out of fear that a newborn might have a poor future <a href="/wiki/Quality_of_life" title="Quality of life">quality of life</a>. With modern medical care, the quality of life of patients has greatly improved.<a href="#cite_note-paediatrics-58">[58]</a> <ul class="gallery mw-gallery-traditional"> <li class="gallerybox" style="width: 155px"> <div class="thumb" style="width: 150px; height: 150px;"><a href="/wiki/File:3D_sonogram_of_fetal_spine.tif" class="mw-file-description" title="Three-dimensional ultrasound image of the fetal spine at 21 weeks of pregnancy"><img alt="Three-dimensional ultrasound image of the fetal spine at 21 weeks of pregnancy" src="//upload.wikimedia.org/wikipedia/commons/thumb/8/86/3D_sonogram_of_fetal_spine.tif/lossy-page1-75px-3D_sonogram_of_fetal_spine.tif.jpg" decoding="async" width="75" height="120" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/8/86/3D_sonogram_of_fetal_spine.tif/lossy-page1-113px-3D_sonogram_of_fetal_spine.tif.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/8/86/3D_sonogram_of_fetal_spine.tif/lossy-page1-150px-3D_sonogram_of_fetal_spine.tif.jpg 2x" data-file-width="773" data-file-height="1232" /></a></div> <div class="gallerytext">Three-dimensional ultrasound image of the fetal spine at 21 weeks of pregnancy</div> </li> <li class="gallerybox" style="width: 155px"> <div class="thumb" style="width: 150px; height: 150px;"><video id="mwe_player_0" poster="//upload.wikimedia.org/wikipedia/commons/thumb/7/75/Spina_bifida_lombare_sagittale.theora.ogv/120px--Spina_bifida_lombare_sagittale.theora.ogv.jpg" controls="" preload="none" data-mw-tmh="" class="mw-file-element" width="120" height="90" data-durationhint="11" data-mwtitle="Spina_bifida_lombare_sagittale.theora.ogv" data-mwprovider="wikimediacommons"><source src="//upload.wikimedia.org/wikipedia/commons/transcoded/7/75/Spina_bifida_lombare_sagittale.theora.ogv/Spina_bifida_lombare_sagittale.theora.ogv.480p.vp9.webm" type="video/webm; codecs="vp9, opus"" data-transcodekey="480p.vp9.webm" data-width="638" data-height="480" /><source src="//upload.wikimedia.org/wikipedia/commons/transcoded/7/75/Spina_bifida_lombare_sagittale.theora.ogv/Spina_bifida_lombare_sagittale.theora.ogv.720p.vp9.webm" type="video/webm; codecs="vp9, opus"" data-transcodekey="720p.vp9.webm" data-width="956" data-height="720" /><source src="//upload.wikimedia.org/wikipedia/commons/7/75/Spina_bifida_lombare_sagittale.theora.ogv" type="video/ogg; codecs="theora"" data-width="976" data-height="735" /><source src="//upload.wikimedia.org/wikipedia/commons/transcoded/7/75/Spina_bifida_lombare_sagittale.theora.ogv/Spina_bifida_lombare_sagittale.theora.ogv.240p.vp9.webm" type="video/webm; codecs="vp9, opus"" data-transcodekey="240p.vp9.webm" data-width="318" data-height="240" /><source src="//upload.wikimedia.org/wikipedia/commons/transcoded/7/75/Spina_bifida_lombare_sagittale.theora.ogv/Spina_bifida_lombare_sagittale.theora.ogv.360p.vp9.webm" type="video/webm; codecs="vp9, opus"" data-transcodekey="360p.vp9.webm" data-width="478" data-height="360" /><source src="//upload.wikimedia.org/wikipedia/commons/transcoded/7/75/Spina_bifida_lombare_sagittale.theora.ogv/Spina_bifida_lombare_sagittale.theora.ogv.360p.webm" type="video/webm; codecs="vp8, vorbis"" data-transcodekey="360p.webm" data-width="478" data-height="360" /></video></div> <div class="gallerytext">Ultrasound view of the fetal spine at 21 weeks of pregnancy. In the longitudinal scan a lumbar myelomeningocele is seen.</div> </li> <li class="gallerybox" style="width: 155px"> <div class="thumb" style="width: 150px; height: 150px;"><video id="mwe_player_1" poster="//upload.wikimedia.org/wikipedia/commons/thumb/5/5b/Lemon_and_banana_sign_for_neural_tube_defect_Dr_Wolfgang_Moroder.theora.ogv/120px--Lemon_and_banana_sign_for_neural_tube_defect_Dr_Wolfgang_Moroder.theora.ogv.jpg" controls="" preload="none" data-mw-tmh="" class="mw-file-element" width="120" height="90" data-durationhint="2" data-mwtitle="Lemon_and_banana_sign_for_neural_tube_defect_Dr_Wolfgang_Moroder.theora.ogv" data-mwprovider="wikimediacommons"><source src="//upload.wikimedia.org/wikipedia/commons/transcoded/5/5b/Lemon_and_banana_sign_for_neural_tube_defect_Dr_Wolfgang_Moroder.theora.ogv/Lemon_and_banana_sign_for_neural_tube_defect_Dr_Wolfgang_Moroder.theora.ogv.480p.vp9.webm" type="video/webm; codecs="vp9, opus"" data-transcodekey="480p.vp9.webm" data-width="640" data-height="480" /><source src="//upload.wikimedia.org/wikipedia/commons/5/5b/Lemon_and_banana_sign_for_neural_tube_defect_Dr_Wolfgang_Moroder.theora.ogv" type="video/ogg; codecs="theora"" data-width="768" data-height="576" /><source src="//upload.wikimedia.org/wikipedia/commons/transcoded/5/5b/Lemon_and_banana_sign_for_neural_tube_defect_Dr_Wolfgang_Moroder.theora.ogv/Lemon_and_banana_sign_for_neural_tube_defect_Dr_Wolfgang_Moroder.theora.ogv.144p.mjpeg.mov" type="video/quicktime" data-transcodekey="144p.mjpeg.mov" data-width="192" data-height="144" /><source src="//upload.wikimedia.org/wikipedia/commons/transcoded/5/5b/Lemon_and_banana_sign_for_neural_tube_defect_Dr_Wolfgang_Moroder.theora.ogv/Lemon_and_banana_sign_for_neural_tube_defect_Dr_Wolfgang_Moroder.theora.ogv.240p.vp9.webm" type="video/webm; codecs="vp9, opus"" data-transcodekey="240p.vp9.webm" data-width="320" data-height="240" /><source src="//upload.wikimedia.org/wikipedia/commons/transcoded/5/5b/Lemon_and_banana_sign_for_neural_tube_defect_Dr_Wolfgang_Moroder.theora.ogv/Lemon_and_banana_sign_for_neural_tube_defect_Dr_Wolfgang_Moroder.theora.ogv.360p.vp9.webm" type="video/webm; codecs="vp9, opus"" data-transcodekey="360p.vp9.webm" data-width="480" data-height="360" /><source src="//upload.wikimedia.org/wikipedia/commons/transcoded/5/5b/Lemon_and_banana_sign_for_neural_tube_defect_Dr_Wolfgang_Moroder.theora.ogv/Lemon_and_banana_sign_for_neural_tube_defect_Dr_Wolfgang_Moroder.theora.ogv.360p.webm" type="video/webm; codecs="vp8, vorbis"" data-transcodekey="360p.webm" data-width="480" data-height="360" /></video></div> <div class="gallerytext"><a href="/wiki/Anatomy_scan" class="mw-redirect" title="Anatomy scan">Anatomy scan</a> of the fetal head at 20 weeks of pregnancy in a fetus affected by spina bifida. In the axial scan the characteristic lemon sign and banana sign are seen.</div> </li> </ul> <div class="mw-heading mw-heading2"><h2 id="Treatment">Treatment</h2>[<a href="/w/index.php?title=Spina_bifida&action=edit&section=15" title="Edit section: Treatment">edit</a>]</div> There is no known cure for the nerve damage caused by spina bifida. Standard treatment is surgery after delivery. This surgery aims to prevent further damage of the nervous tissue and to prevent infection; <a href="/wiki/Pediatric" class="mw-redirect" title="Pediatric">pediatric</a> <a href="/wiki/Neurosurgeons" class="mw-redirect" title="Neurosurgeons">neurosurgeons</a> operate to close the opening on the back. The spinal cord and its nerve roots are put back inside the spine and covered with <a href="/wiki/Meninges" title="Meninges">meninges</a>. In addition, a <a href="/wiki/Shunt_(medical)" title="Shunt (medical)">shunt</a> may be surgically installed to provide a continuous drain for the excess cerebrospinal fluid produced in the brain, as happens with <a href="/wiki/Hydrocephalus" title="Hydrocephalus">hydrocephalus</a>. Shunts most commonly drain into the <a href="/wiki/Abdomen" title="Abdomen">abdomen</a> or chest wall.[<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>] <div class="mw-heading mw-heading3"><h3 id="Pregnancy">Pregnancy</h3>[<a href="/w/index.php?title=Spina_bifida&action=edit&section=16" title="Edit section: Pregnancy">edit</a>]</div> Standard treatment is after delivery. There is tentative evidence about treatment for severe disease before delivery while the baby is inside the womb.<a href="#cite_note-Ad2013-73">[73]</a> As of 2014, however, the evidence remains insufficient to determine benefits and harms.<a href="#cite_note-74">[74]</a> Treatment of spina bifida during pregnancy is not without risk.<a href="#cite_note-Ad2013-73">[73]</a> To the mother, this includes scarring of the uterus.<a href="#cite_note-Ad2013-73">[73]</a> To the baby, there is the risk of preterm birth.<a href="#cite_note-Ad2013-73">[73]</a> Broadly, there are two forms of prenatal treatment. The first is open fetal surgery, where the uterus is opened and the spina bifida repair performed. The second is via fetoscopy. These techniques may be an option to standard therapy.<a href="#cite_note-75">[75]</a> <div class="mw-heading mw-heading3"><h3 id="Childhood">Childhood</h3>[<a href="/w/index.php?title=Spina_bifida&action=edit&section=17" title="Edit section: Childhood">edit</a>]</div> Most individuals with myelomeningocele will need periodic evaluations by a variety of specialists:<a href="#cite_note-Gillette_Children's-76">[76]</a> <ul><li><a href="/wiki/Physiatry" class="mw-redirect" title="Physiatry">Physiatrists</a> coordinate the rehabilitation efforts of different therapists and prescribe specific therapies, adaptive equipment, or medications to encourage as high of a functional performance within the community as possible.</li> <li><a href="/wiki/Orthopedic_surgery" title="Orthopedic surgery">Orthopedists</a> monitor growth and development of bones, muscles, and joints.</li> <li><a href="/wiki/Neurosurgery" title="Neurosurgery">Neurosurgeons</a> perform surgeries at birth and manage complications associated with tethered cord and hydrocephalus.</li> <li><a href="/wiki/Neurology" title="Neurology">Neurologists</a> treat and evaluate nervous system issues, such as seizure disorders.</li> <li><a href="/wiki/Urology" title="Urology">Urologists</a> to address kidney, bladder, and bowel dysfunction – many will need to manage their urinary systems with a program of <a href="/wiki/Catheterization" class="mw-redirect" title="Catheterization">catheterization</a>. Bowel management programs aimed at improving elimination are also designed.</li> <li>Colorectal specialists help restore bowel and urinary control and function.<a href="#cite_note-77">[77]</a></li> <li><a href="/wiki/Ophthalmology" title="Ophthalmology">Ophthalmologists</a> evaluate and treat complications of the eyes.</li> <li><a href="/wiki/Orthotics" title="Orthotics">Orthotists</a> design and customize various types of assistive technology, including braces, crutches, walkers, and wheelchairs to aid in mobility. As a general rule, the higher the level of the spina bifida defect, the more severe the paralysis, but paralysis does not always occur. Thus, those with low levels may need only short leg braces, whereas those with higher levels do best with a wheelchair, and some may be able to walk unaided.</li> <li><a href="/wiki/Physical_therapy" title="Physical therapy">Physical therapists</a>, <a href="/wiki/Occupational_therapy" title="Occupational therapy">occupational therapists</a>, <a href="/wiki/Psychologist" title="Psychologist">psychologists</a>, and <a href="/wiki/Speech_and_language_pathology" class="mw-redirect" title="Speech and language pathology">speech/language pathologists</a> aid in rehabilitative therapies and increase independent living skills.</li></ul> <div class="mw-heading mw-heading3"><h3 id="Transition_to_adulthood">Transition to adulthood</h3>[<a href="/w/index.php?title=Spina_bifida&action=edit&section=18" title="Edit section: Transition to adulthood">edit</a>]</div> Although many <a href="/wiki/Children%27s_hospital" title="Children's hospital">children's hospitals</a> feature integrated multidisciplinary teams to coordinate healthcare of youth with spina bifida, the transition to adult healthcare can be difficult because the above healthcare professionals operate independently of each other, requiring separate appointments, and communicate among each other much less frequently. Healthcare professionals working with adults may also be less knowledgeable about spina bifida because it is considered a childhood chronic health condition.<a href="#cite_note-Binks_et_al-78">[78]</a> Due to the potential difficulties of the transition, adolescents with spina bifida and their families are encouraged to begin to prepare for the transition around ages 14–16, although this may vary depending on the adolescent's cognitive and physical abilities and available family support. The transition itself should be gradual and flexible. The adolescent's multidisciplinary treatment team may aid in the process by preparing comprehensive, up-to-date documents detailing the adolescent's medical care, including information about medications, surgery, therapies, and recommendations. A transition plan and aid in identifying adult healthcare professionals are also helpful to include in the transition process.<a href="#cite_note-Binks_et_al-78">[78]</a> Further complicating the transition process is the tendency for youths with spina bifida to be delayed in the development of autonomy,<a href="#cite_note-Davis_et_al_2006-79">[79]</a> with boys particularly at risk for slower development of independence.<a href="#cite_note-Friedman_2009-80">[80]</a> An increased dependence on others (in particular family members) may interfere with the adolescent's self-management of health-related tasks, such as catheterization, bowel management, and taking medications.<a href="#cite_note-Monsen_1992-81">[81]</a> As part of the transition process, it is beneficial to begin discussions at an early age about educational and vocational goals, independent living, and community involvement.<a href="#cite_note-Holmbeck_&_Devine_2010-82">[82]</a> Certain locations feature multidisciplinary clinics in order to offer coordinated care between specialists, such as Cincinnati Children's Center for Spina Bifida.<a href="#cite_note-83">[83]</a> <div class="mw-heading mw-heading2"><h2 id="Epidemiology">Epidemiology</h2>[<a href="/w/index.php?title=Spina_bifida&action=edit&section=19" title="Edit section: Epidemiology">edit</a>]</div> Rates of spina bifida vary significantly by country from 0.1 to 5 per 1000 births.<a href="#cite_note-Springer-15">[15]</a> In high income and upper-middle income countries with folate fortification of foodstuffs public health programs, including in North America, the incidence of spina bifida is 34–37 cases per 100,000 live births. In countries without folate fortification programs nor widespread maternal folate supplementation, the incidence is 54–87 cases per 100,000 live births. And in low income countries or regions without folic acid supplementation nor fortification, the incidence is 300 cases per 100,000 live births.<a href="#cite_note-Iskandar_2022-59">[59]</a> In India, about 1.9 per 1000 live births are affected by spina bifida.<a href="#cite_note-ReferenceC-17">[17]</a> In the United States, rates are higher on the East Coast than on the West Coast, and higher in white people (one case per 1000 live births) than in black people (0.1–0.4 case per 1000 live births). Immigrants from Ireland have a higher incidence of spina bifida than do natives.<a href="#cite_note-Lemire-84">[84]</a><a href="#cite_note-Cotton-85">[85]</a> Highest rates of the defect in the USA can be found in Hispanic youth.<a href="#cite_note-86">[86]</a> The highest incidence rates worldwide were found in Ireland and Wales, where three to four cases of myelomeningocele per 1000 population have been reported during the 1970s, along with more than six cases of <a href="/wiki/Anencephaly" title="Anencephaly">anencephaly</a> (both live births and <a href="/wiki/Stillbirth" title="Stillbirth">stillbirths</a>) per 1000 population. The reported overall incidence of myelomeningocele in the British Isles was 2.0–3.5 cases per 1000 births.<a href="#cite_note-Lemire-84">[84]</a><a href="#cite_note-Cotton-85">[85]</a> Since then, the rate has fallen dramatically with 0.15 per 1000 live births reported in 1998,<a href="#cite_note-paediatrics-58">[58]</a> though this decline is partially accounted for because some fetuses are aborted when tests show signs of spina bifida (see <a class="mw-selflink-fragment" href="#Pregnancy_screening">Pregnancy screening</a> above). <div class="mw-heading mw-heading2"><h2 id="History">History</h2>[<a href="/w/index.php?title=Spina_bifida&action=edit&section=20" title="Edit section: History">edit</a>]</div> Although <a href="/wiki/Hippocratic" class="mw-redirect" title="Hippocratic">Hippocratic</a> doctors were aware of developmental abnormalities involving the lower spine, the first person to describe a spinal spina bifida was a Persian physician <a href="/wiki/Abu_Bakr_al-Razi" title="Abu Bakr al-Razi">Al-Razi</a> (Rhazes, 865–925 AD).<a href="#cite_note-87">[87]</a><a href="#cite_note-88">[88]</a><a href="#cite_note-89">[89]</a> He gave the earliest accurate account of the morbid anatomy associated with spina bifida.<a href="#cite_note-90">[90]</a> <div class="mw-heading mw-heading2"><h2 id="Research">Research</h2>[<a href="/w/index.php?title=Spina_bifida&action=edit&section=21" title="Edit section: Research">edit</a>]</div> <ul><li>1980 – Fetal surgical techniques using animal models were first developed at the <a href="/wiki/University_of_California,_San_Francisco" title="University of California, San Francisco">University of California, San Francisco</a> by Michael R. Harrison, <a href="/wiki/N._Scott_Adzick" title="N. Scott Adzick">N. Scott Adzick</a> and research colleagues.</li> <li>1994 – A surgical model that simulates the human disease is the fetal lamb model of myelomeningocele (MMC) introduced by Meuli and Adzick in 1994. The MMC-like defect was surgically created at 75 days of gestation (term 145 to 150 days) by a lumbo-sacral <a href="/wiki/Laminectomy" title="Laminectomy">laminectomy</a>. Approximately 3 weeks after creation of the defect a reversed <a href="/wiki/Latissimus_dorsi" class="mw-redirect" title="Latissimus dorsi">latissimus dorsi</a> flap was used to cover the exposed <a href="/w/index.php?title=Neural_placode&action=edit&redlink=1" class="new" title="Neural placode (page does not exist)">neural placode</a> and the animals were delivered by cesarean section just prior term. Human MMC-like lesions with similar <a href="/wiki/Neurological_deficit" class="mw-redirect" title="Neurological deficit">neurological deficit</a> were found in the control newborn lambs. In contrast, animals that underwent closure had near-normal neurological function and well-preserved <a href="/wiki/Cytoarchitecture" title="Cytoarchitecture">cytoarchitecture</a> of the covered spinal cord on <a href="/wiki/Histopathology" title="Histopathology">histopathological examination</a>. Despite mild <a href="/wiki/Paraparesis" class="mw-redirect" title="Paraparesis">paraparesis</a>, they were able to stand, walk, perform demanding motor test and demonstrated no signs of incontinence. Furthermore, sensory function of the hind limbs was present clinically and confirmed electrophysiologically. Further studies showed that this model, when combined with a lumbar spinal cord <a href="/wiki/Myelotomy" class="mw-redirect" title="Myelotomy">myelotomy</a> leads to the hindbrain herniation characteristic of the Chiari II malformation and that in utero surgery restores normal hindbrain anatomy by stopping the leak of cerebrospinal fluid through the myelomeningocele lesion.<a href="#cite_note-91">[91]</a><a href="#cite_note-92">[92]</a><a href="#cite_note-93">[93]</a><a href="#cite_note-94">[94]</a></li></ul> Surgeons at <a href="/wiki/Vanderbilt_University" title="Vanderbilt University">Vanderbilt University</a>, led by Joseph Bruner, attempted to close spina bifida in 4 human fetuses using a skin graft from the mother using a <a href="/wiki/Laparoscope" class="mw-redirect" title="Laparoscope">laparoscope</a>. Four cases were performed before stopping the procedure - two of the four fetuses died.<a href="#cite_note-95">[95]</a> <ul><li>1998 – N. Scott Adzick and team at The Children's Hospital of Philadelphia performed open fetal surgery for spina bifida in an early gestation fetus (22-week gestation fetus) with a successful outcome.<a href="#cite_note-96">[96]</a> Open fetal surgery for myelomeningocele involves surgically opening the pregnant mother's abdomen and uterus to operate on the fetus. The exposed fetal spinal cord is covered in layers with surrounding fetal tissue at mid-gestation (19–25 weeks) to protect it from further damage caused by prolonged exposure to amniotic fluid. Between 1998 and 2003, Dr. Adzick, and his colleagues in the Center for Fetal Diagnosis and Treatment at The Children's Hospital Of Philadelphia, performed prenatal spina bifida repair in 58 mothers and observed significant benefit in the babies.</li></ul> Fetal surgery after 25 weeks has not shown benefit in subsequent studies.<a href="#cite_note-97">[97]</a> <div class="mw-heading mw-heading3"><h3 id="MOMS_trial">MOMS trial</h3>[<a href="/w/index.php?title=Spina_bifida&action=edit&section=22" title="Edit section: MOMS trial">edit</a>]</div> <a href="/wiki/MOMS_Trial" title="MOMS Trial">Management of myelomeningocele study</a> (MOMS) was a <a href="/wiki/Clinical_trial" title="Clinical trial">phase III clinical trial</a> designed to compare two approaches to the treatment of spina bifida: surgery before birth and surgery after birth.<a href="#cite_note-98">[98]</a><a href="#cite_note-99">[99]</a> The trial concluded that the outcomes after prenatal spina bifida treatment are improved to the degree that the benefits of the surgery outweigh the maternal risks. This conclusion requires a value judgment on the relative value of fetal and maternal outcomes on which opinion is still divided.<a href="#cite_note-100">[100]</a> To be specific, the study found that prenatal repair resulted in: <ul><li>Reversal of the hindbrain herniation component of the Chiari II malformation</li> <li>Reduced need for ventricular shunting (a procedure in which a thin tube is introduced into the brain's ventricles to drain fluid and relieve hydrocephalus)</li> <li>Reduced incidence or severity of potentially devastating <a href="/wiki/Neurologic" class="mw-redirect" title="Neurologic">neurologic</a> effects caused by the spine's exposure to amniotic fluid, such as impaired motor function</li></ul> <a href="#cite_note-nejm.org-101">[101]</a> At one year of age, 40 percent of the children in the prenatal surgery group had received a shunt, compared to 83 percent of the children in the postnatal group. During pregnancy, all the fetuses in the trial had hindbrain herniation. However, at age 12 months, one-third (36 percent) of the infants in the prenatal surgery group no longer had any evidence of hindbrain herniation, compared to only 4 percent in the postnatal surgery group.<a href="#cite_note-nejm.org-101">[101]</a> Further surveillance is ongoing.<a href="#cite_note-102">[102]</a> <div class="mw-heading mw-heading3"><h3 id="Fetoscopic_surgery">Fetoscopic surgery</h3>[<a href="/w/index.php?title=Spina_bifida&action=edit&section=23" title="Edit section: Fetoscopic surgery">edit</a>]</div> <style data-mw-deduplicate="TemplateStyles:r1236090951">.mw-parser-output .hatnote{font-style:italic}.mw-parser-output div.hatnote{padding-left:1.6em;margin-bottom:0.5em}.mw-parser-output .hatnote i{font-style:normal}.mw-parser-output .hatnote+link+.hatnote{margin-top:-0.5em}@media print{body.ns-0 .mw-parser-output .hatnote{display:none!important}}</style><div role="note" class="hatnote navigation-not-searchable">See also: <a href="/wiki/Fetal_surgery" title="Fetal surgery">Fetal surgery</a></div> In contrast to the open fetal operative approach performed in the MOMS trial, a minimally invasive fetoscopic approach (akin to 'keyhole' surgery) has been developed. This approach has been evaluated by independent authors of a controlled study which showed some benefit in survivors,<a href="#cite_note-VERBEEK_2011_15–22-103">[103]</a> but others are more skeptical.<a href="#cite_note-104">[104]</a> The observations in mothers and their fetuses that were operated over the past two and a half years by the matured minimally invasive approach showed the following results: Compared to the open fetal surgery technique, fetoscopic repair of myelomeningocele results in far less surgical trauma to the mother, as large incisions of her abdomen and uterus are not required. In contrast, the initial punctures have a diameter of 1.2 mm only. As a result, thinning of the uterine wall or <a href="/wiki/Wound_dehiscence" title="Wound dehiscence">dehiscence</a> which have been among the most worrisome and criticized complications after the open operative approach do not occur following minimally invasive fetoscopic closure of spina bifida aperta. The risks of maternal <a href="/wiki/Chorioamnionitis" title="Chorioamnionitis">chorioamnionitis</a> or fetal death as a result of the fetoscopic procedure run below 5%.<a href="#cite_note-105">[105]</a><a href="#cite_note-106">[106]</a><a href="#cite_note-107">[107]</a> Women are discharged home from hospital one week after the procedure. There is no need for chronic administration of <a href="/wiki/Tocolytic_agent" class="mw-redirect" title="Tocolytic agent">tocolytic agents</a> since postoperative uterine contractions are barely ever observed. The current cost of the entire fetoscopic procedure, including hospital stay, drugs, perioperative clinical, ECG, ultrasound and MRI-examinations, is approximately €16,000.[<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>] In 2012, these results of the fetoscopic approach were presented at various national and international meetings, among them at the 1st European Symposium "Fetal Surgery for Spina bifida" in April 2012 in <a href="/wiki/Giessen" title="Giessen">Giessen</a>, at the 15th Congress of the <a href="/w/index.php?title=German_Society_for_Prenatal_Medicine_and_Obstetrics&action=edit&redlink=1" class="new" title="German Society for Prenatal Medicine and Obstetrics (page does not exist)">German Society for Prenatal Medicine and Obstetrics</a> in May 2012 in Bonn,<a href="#cite_note-108">[108]</a> at the World Congress of the Fetal Medicine Foundation in June 2012<a href="#cite_note-109">[109]</a> and at the World Congress of the <a href="/wiki/International_Society_of_Ultrasound_in_Obstetrics_and_Gynecology" title="International Society of Ultrasound in Obstetrics and Gynecology">International Society of Obstetrics and Gynecology</a> (ISUOG) in <a href="/wiki/Copenhagen" title="Copenhagen">Copenhagen</a> in September 2012,<a href="#cite_note-110">[110]</a> and published in abstract form.<a href="#cite_note-111">[111]</a><a href="#cite_note-112">[112]</a><a href="#cite_note-113">[113]</a><a href="#cite_note-114">[114]</a><a href="#cite_note-115">[115]</a><a href="#cite_note-116">[116]</a><a href="#cite_note-117">[117]</a><a href="#cite_note-118">[118]</a>[<a href="/wiki/Wikipedia:Citing_sources#Bundling_citations" title="Wikipedia:Citing sources">excessive citations</a>] Since then more data has emerged. In 2014, two papers were published on fifty one patients.<a href="#cite_note-119">[119]</a><a href="#cite_note-120">[120]</a> These papers suggested that the risk to the mother is small. The main risk appears to be preterm labour, on average at about 33 weeks.[<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>] <div class="mw-heading mw-heading3"><h3 id="Placenta">Placenta</h3>[<a href="/w/index.php?title=Spina_bifida&action=edit&section=24" title="Edit section: Placenta">edit</a>]</div> The placenta is a critical determinant of fetal growth, yet placental development has not been well studied in pregnancies with fetal neural tube defects. Folate bioavailability is associated not only with isolated fetal neural tube defects, but is also required for optimal placental development. Pregnancies with folate-responsive neural tube defects may thus be at increased risk for poor placental development. A study comprehensively assessing the prevalence of placental pathology in a large cohort of fetuses with isolated neural tube defects found that these fetuses had higher risk of placental pathology and altered offspring growth outcomes at birth compared to controls, suggesting increased risk of placental maldevelopment that may contribute to poor fetal growth in pregnancies with neural tube defects.<a href="#cite_note-121">[121]</a> <div class="mw-heading mw-heading2"><h2 id="See_also">See also</h2>[<a href="/w/index.php?title=Spina_bifida&action=edit&section=25" title="Edit section: See also">edit</a>]</div> <ul><li><a href="/wiki/Meningohydroencephalocoele" title="Meningohydroencephalocoele">Meningohydroencephalocoele</a></li> <li><a href="/wiki/Rachischisis" title="Rachischisis">Rachischisis</a></li> <li><a href="/wiki/Congenital_dermal_sinus" title="Congenital dermal sinus">Congenital dermal sinus</a></li></ul> <div class="mw-heading mw-heading2"><h2 id="References">References</h2>[<a href="/w/index.php?title=Spina_bifida&action=edit&section=26" title="Edit section: References">edit</a>]</div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist"> <div class="mw-references-wrap mw-references-columns"><ol class="references"> <li id="cite_note-NIH2012Over-1">^ <a href="#cite_ref-NIH2012Over_1-0">a</a> <a href="#cite_ref-NIH2012Over_1-1">b</a> <a href="#cite_ref-NIH2012Over_1-2">c</a> <a href="#cite_ref-NIH2012Over_1-3">d</a> <a href="#cite_ref-NIH2012Over_1-4">e</a> <style data-mw-deduplicate="TemplateStyles:r1238218222">.mw-parser-output cite.citation{font-style:inherit;word-wrap:break-word}.mw-parser-output .citation q{quotes:"\"""\"""'""'"}.mw-parser-output .citation:target{background-color:rgba(0,127,255,0.133)}.mw-parser-output .id-lock-free.id-lock-free a{background:url("//upload.wikimedia.org/wikipedia/commons/6/65/Lock-green.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-limited.id-lock-limited a,.mw-parser-output .id-lock-registration.id-lock-registration a{background:url("//upload.wikimedia.org/wikipedia/commons/d/d6/Lock-gray-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-subscription.id-lock-subscription a{background:url("//upload.wikimedia.org/wikipedia/commons/a/aa/Lock-red-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .cs1-ws-icon a{background:url("//upload.wikimedia.org/wikipedia/commons/4/4c/Wikisource-logo.svg")right 0.1em center/12px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-free a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-limited a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain;padding:0 1em 0 0}.mw-parser-output .cs1-code{color:inherit;background:inherit;border:none;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;color:var(--color-error,#d33)}.mw-parser-output .cs1-visible-error{color:var(--color-error,#d33)}.mw-parser-output .cs1-maint{display:none;color:#085;margin-left:0.3em}.mw-parser-output .cs1-kern-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right{padding-right:0.2em}.mw-parser-output .citation .mw-selflink{font-weight:inherit}@media screen{.mw-parser-output .cs1-format{font-size:95%}html.skin-theme-clientpref-night .mw-parser-output .cs1-maint{color:#18911f}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .cs1-maint{color:#18911f}}</style><cite class="citation web cs1"><a rel="nofollow" class="external text" href="http://www.nichd.nih.gov/health/topics/spinabifida/conditioninfo/Pages/default.aspx">"Spina Bifida: Condition Information"</a>. 2012-11-30. <a rel="nofollow" class="external text" href="https://web.archive.org/web/20150518075105/http://www.nichd.nih.gov/health/topics/spinabifida/conditioninfo/Pages/default.aspx">Archived</a> from the original on 2015-05-18.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Spina+Bifida%3A+Condition+Information&rft.date=2012-11-30&rft_id=http%3A%2F%2Fwww.nichd.nih.gov%2Fhealth%2Ftopics%2Fspinabifida%2Fconditioninfo%2FPages%2Fdefault.aspx&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASpina+bifida" class="Z3988"> </li> <li id="cite_note-NIH2012Sym-2">^ <a href="#cite_ref-NIH2012Sym_2-0">a</a> <a href="#cite_ref-NIH2012Sym_2-1">b</a> <a href="#cite_ref-NIH2012Sym_2-2">c</a> <a href="#cite_ref-NIH2012Sym_2-3">d</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="http://www.nichd.nih.gov/health/topics/spinabifida/conditioninfo/Pages/disorders-conditions.aspx">"Are there disorders or conditions associated with spina bifida?"</a>. 2012-11-30. <a rel="nofollow" class="external text" href="https://web.archive.org/web/20150518075103/http://www.nichd.nih.gov/health/topics/spinabifida/conditioninfo/Pages/disorders-conditions.aspx">Archived</a> from the original on 18 May 2015. Retrieved 8 May 2015.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Are+there+disorders+or+conditions+associated+with+spina+bifida%3F&rft.date=2012-11-30&rft_id=http%3A%2F%2Fwww.nichd.nih.gov%2Fhealth%2Ftopics%2Fspinabifida%2Fconditioninfo%2FPages%2Fdisorders-conditions.aspx&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASpina+bifida" class="Z3988"> </li> <li id="cite_note-NIH2012Ca-3">^ <a href="#cite_ref-NIH2012Ca_3-0">a</a> <a href="#cite_ref-NIH2012Ca_3-1">b</a> <a href="#cite_ref-NIH2012Ca_3-2">c</a> <a href="#cite_ref-NIH2012Ca_3-3">d</a> <a href="#cite_ref-NIH2012Ca_3-4">e</a> <a href="#cite_ref-NIH2012Ca_3-5">f</a> <a href="#cite_ref-NIH2012Ca_3-6">g</a> <a href="#cite_ref-NIH2012Ca_3-7">h</a> <a href="#cite_ref-NIH2012Ca_3-8">i</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="http://www.nichd.nih.gov/health/topics/spinabifida/conditioninfo/Pages/causes.aspx">"What causes spina bifida?"</a>. 2012-11-30. <a rel="nofollow" class="external text" href="https://web.archive.org/web/20150518073039/http://www.nichd.nih.gov/health/topics/spinabifida/conditioninfo/Pages/causes.aspx">Archived</a> from the original on 18 May 2015. 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style="width:1%;background: #EAECF0;color:black;">Classification</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"><div style="position:relative; float:right; font-size:0.8em;"><a href="https://www.wikidata.org/wiki/Q844717" class="extiw" title="d:Q844717">D</a></div><div class="hlist" style="text-align:left;"><ul><li><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/ICD-10" title="ICD-10">10</a>: <a rel="nofollow" class="external text" href="https://icd.who.int/browse10/2019/en#/Q05">Q05</a>, <a rel="nofollow" class="external text" href="https://icd.who.int/browse10/2019/en#/Q76.0">Q76.0</a></li><li><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/List_of_ICD-9_codes" title="List of ICD-9 codes">9-CM</a>: <a rel="nofollow" class="external text" href="http://www.icd9data.com/getICD9Code.ashx?icd9=741">741</a>, <a rel="nofollow" class="external text" href="http://www.icd9data.com/getICD9Code.ashx?icd9=756.17">756.17</a></li><li><a href="/wiki/Online_Mendelian_Inheritance_in_Man" title="Online Mendelian Inheritance in Man">OMIM</a>: <a rel="nofollow" class="external text" href="https://omim.org/entry/182940">182940</a></li><li><a href="/wiki/Diseases_Database" title="Diseases Database">DiseasesDB</a>: <a rel="nofollow" class="external text" href="http://www.diseasesdatabase.com/ddb12306.htm">12306</a></li></ul></div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0;color:black;">External resources</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"><div class="hlist" style="text-align:left;"><ul><li><a href="/wiki/EMedicine" title="EMedicine">eMedicine</a>: <a rel="nofollow" class="external text" href="https://emedicine.medscape.com/orthoped/557-overview">orthoped/557</a></li><li><a href="/wiki/Patient_UK" title="Patient UK">Patient UK</a>: <a rel="nofollow" class="external text" href="https://patient.info/doctor/spina-bifida-pro">Spina bifida</a></li></ul></div></div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Congenital_malformations_and_deformations_of_nervous_system" style="padding:3px"><table class="nowraplinks mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><style data-mw-deduplicate="TemplateStyles:r1239400231">.mw-parser-output .navbar{display:inline;font-size:88%;font-weight:normal}.mw-parser-output .navbar-collapse{float:left;text-align:left}.mw-parser-output .navbar-boxtext{word-spacing:0}.mw-parser-output .navbar ul{display:inline-block;white-space:nowrap;line-height:inherit}.mw-parser-output .navbar-brackets::before{margin-right:-0.125em;content:"[ "}.mw-parser-output .navbar-brackets::after{margin-left:-0.125em;content:" ]"}.mw-parser-output .navbar li{word-spacing:-0.125em}.mw-parser-output .navbar a>span,.mw-parser-output .navbar a>abbr{text-decoration:inherit}.mw-parser-output .navbar-mini abbr{font-variant:small-caps;border-bottom:none;text-decoration:none;cursor:inherit}.mw-parser-output .navbar-ct-full{font-size:114%;margin:0 7em}.mw-parser-output .navbar-ct-mini{font-size:114%;margin:0 4em}html.skin-theme-clientpref-night .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}@media(prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}}@media print{.mw-parser-output .navbar{display:none!important}}</style><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Congenital_malformations_and_deformations_of_nervous_system" title="Template:Congenital malformations and deformations of nervous system"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Congenital_malformations_and_deformations_of_nervous_system" title="Template talk:Congenital malformations and deformations of nervous system"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Congenital_malformations_and_deformations_of_nervous_system" title="Special:EditPage/Template:Congenital malformations and deformations of nervous system"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Congenital_malformations_and_deformations_of_nervous_system" style="font-size:114%;margin:0 4em"><a href="/wiki/Congenital_disorder" class="mw-redirect" title="Congenital disorder">Congenital</a> malformations and deformations of <a href="/wiki/Nervous_system" title="Nervous system">nervous system</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Human_brain" title="Human brain">Brain</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Neural_tube_defect" title="Neural tube defect">Neural tube defect</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Anencephaly" title="Anencephaly">Anencephaly</a> <ul><li>Acephaly</li> <li><a href="/wiki/Acrania" title="Acrania">Acrania</a></li> <li><a href="/wiki/Acalvaria" title="Acalvaria">Acalvaria</a></li> <li><a href="/wiki/Iniencephaly" title="Iniencephaly">Iniencephaly</a></li></ul></li> <li><a href="/wiki/Encephalocele" title="Encephalocele">Encephalocele</a></li> <li><a href="/wiki/Chiari_malformation" title="Chiari malformation">Chiari malformation</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Microcephaly" title="Microcephaly">Microcephaly</a></li> <li><a href="/wiki/Hydrocephalus" title="Hydrocephalus">Congenital hydrocephalus</a> <ul><li><a href="/wiki/Dandy%E2%80%93Walker_syndrome" class="mw-redirect" title="Dandy–Walker syndrome">Dandy–Walker syndrome</a></li></ul></li></ul> <ul><li>other reduction deformities <ul><li><a href="/wiki/Holoprosencephaly" title="Holoprosencephaly">Holoprosencephaly</a></li> <li><a href="/wiki/Lissencephaly" title="Lissencephaly">Lissencephaly</a></li> <li><a href="/wiki/Microlissencephaly" title="Microlissencephaly">Microlissencephaly</a></li> <li><a href="/wiki/Pachygyria" title="Pachygyria">Pachygyria</a></li> <li><a href="/wiki/Hydranencephaly" title="Hydranencephaly">Hydranencephaly</a></li></ul></li></ul> <ul><li><a href="/wiki/Agenesis_of_the_corpus_callosum" title="Agenesis of the corpus callosum">Agenesis of the corpus callosum</a></li> <li><a href="/wiki/Septo-optic_dysplasia" title="Septo-optic dysplasia">Septo-optic dysplasia</a></li> <li><a href="/wiki/Megalencephaly" title="Megalencephaly">Megalencephaly</a></li> <li><a href="/wiki/Hemimegalencephaly" title="Hemimegalencephaly">Hemimegalencephaly</a></li></ul> <ul><li><a href="/wiki/Central_nervous_system_cyst" title="Central nervous system cyst">CNS cyst</a> <ul><li><a href="/wiki/Porencephaly" title="Porencephaly">Porencephaly</a></li> <li><a href="/wiki/Schizencephaly" title="Schizencephaly">Schizencephaly</a></li></ul></li></ul> <ul><li><a href="/wiki/Polymicrogyria" title="Polymicrogyria">Polymicrogyria</a> <ul><li><a href="/wiki/Bilateral_frontoparietal_polymicrogyria" title="Bilateral frontoparietal polymicrogyria">Bilateral frontoparietal polymicrogyria</a></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Spinal_cord" title="Spinal cord">Spinal cord</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Neural_tube_defect" title="Neural tube defect">Neural tube defect</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a class="mw-selflink selflink">Spina bifida</a></li> <li><a href="/wiki/Rachischisis" title="Rachischisis">Rachischisis</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Currarino_syndrome" title="Currarino syndrome">Currarino syndrome</a></li> <li><a href="/wiki/Diastomatomyelia" class="mw-redirect" title="Diastomatomyelia">Diastomatomyelia</a></li> <li><a href="/wiki/Syringomyelia" title="Syringomyelia">Syringomyelia</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Congenital_malformations_and_deformations_of_musculoskeletal_system_/_musculoskeletal_abnormality" style="padding:3px"><table class="nowraplinks mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231"><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Congenital_malformations_and_deformations_of_musculoskeletal_system" title="Template:Congenital malformations and deformations of musculoskeletal system"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Congenital_malformations_and_deformations_of_musculoskeletal_system" title="Template talk:Congenital malformations and deformations of musculoskeletal system"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Congenital_malformations_and_deformations_of_musculoskeletal_system" title="Special:EditPage/Template:Congenital malformations and deformations of musculoskeletal system"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Congenital_malformations_and_deformations_of_musculoskeletal_system_/_musculoskeletal_abnormality" style="font-size:114%;margin:0 4em"><a href="/wiki/Congenital_disorder" class="mw-redirect" title="Congenital disorder">Congenital</a> malformations and deformations of <a href="/wiki/Human_musculoskeletal_system" title="Human musculoskeletal system">musculoskeletal system</a> / <a href="/wiki/Musculoskeletal_abnormality" title="Musculoskeletal abnormality">musculoskeletal abnormality</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Appendicular_skeleton" title="Appendicular skeleton">Appendicular</a> <a href="/wiki/Congenital_limb_deformities" title="Congenital limb deformities">limb</a> / <a href="/wiki/Dysmelia" title="Dysmelia">dysmelia</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Arm" title="Arm">Arms</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Clavicle" title="Clavicle">clavicle</a> / <a href="/wiki/Shoulder" title="Shoulder">shoulder</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Cleidocranial_dysostosis" title="Cleidocranial dysostosis">Cleidocranial dysostosis</a></li> <li><a href="/wiki/Sprengel%27s_deformity" title="Sprengel's deformity">Sprengel's deformity</a></li> <li><a href="/wiki/Wallis%E2%80%93Zieff%E2%80%93Goldblatt_syndrome" title="Wallis–Zieff–Goldblatt syndrome">Wallis–Zieff–Goldblatt syndrome</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Hand_deformity" title="Hand deformity">hand deformity</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Madelung%27s_deformity" title="Madelung's deformity">Madelung's deformity</a></li> <li><a href="/wiki/Clinodactyly" title="Clinodactyly">Clinodactyly</a></li> <li><a href="/wiki/Oligodactyly" title="Oligodactyly">Oligodactyly</a></li> <li><a href="/wiki/Polydactyly" title="Polydactyly">Polydactyly</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Human_leg" title="Human leg">Leg</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Hip" title="Hip">hip</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Hip_dislocation" title="Hip dislocation">Hip dislocation</a> / <a href="/wiki/Hip_dysplasia" title="Hip dysplasia">Hip dysplasia</a></li> <li><a href="/wiki/Upington_disease" title="Upington disease">Upington disease</a></li> <li><a href="/wiki/Coxa_valga" title="Coxa valga">Coxa valga</a></li> <li><a href="/wiki/Coxa_vara" title="Coxa vara">Coxa vara</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Knee" title="Knee">knee</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Genu_valgum" title="Genu valgum">Genu valgum</a></li> <li><a href="/wiki/Genu_varum" title="Genu varum">Genu varum</a></li> <li><a href="/wiki/Genu_recurvatum" title="Genu recurvatum">Genu recurvatum</a></li> <li><a href="/wiki/Discoid_meniscus" title="Discoid meniscus">Discoid meniscus</a></li> <li><a href="/wiki/Congenital_patellar_dislocation" class="mw-redirect" title="Congenital patellar dislocation">Congenital patellar dislocation</a></li> <li><a href="/wiki/Congenital_knee_dislocation" class="mw-redirect" title="Congenital knee dislocation">Congenital knee dislocation</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Foot_deformity" title="Foot deformity">foot deformity</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Varus_deformity" title="Varus deformity">varus</a> <ul><li><a href="/wiki/Club_foot" class="mw-redirect" title="Club foot">Club foot</a></li> <li><a href="/wiki/Pigeon_toe" title="Pigeon toe">Pigeon toe</a></li></ul></li> <li><a href="/wiki/Valgus_deformity" title="Valgus deformity">valgus</a> <ul><li><a href="/wiki/Flat_feet" title="Flat feet">Flat feet</a></li></ul></li> <li><a href="/wiki/Pes_cavus" title="Pes cavus">Pes cavus</a></li> <li><a href="/wiki/Rocker_bottom_foot" title="Rocker bottom foot">Rocker bottom foot</a></li> <li><a href="/wiki/Hammer_toe" title="Hammer toe">Hammer toe</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Either / both</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Dactyly" title="Dactyly">fingers and toes</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Polydactyly" title="Polydactyly">Polydactyly</a> / <a href="/wiki/Syndactyly" title="Syndactyly">Syndactyly</a> <ul><li><a href="/wiki/Webbed_toes" title="Webbed toes">Webbed toes</a></li></ul></li> <li><a href="/wiki/Arachnodactyly" title="Arachnodactyly">Arachnodactyly</a></li> <li><a href="/wiki/Cenani%E2%80%93Lenz_syndactylism" title="Cenani–Lenz syndactylism">Cenani–Lenz syndactylism</a></li> <li><a href="/wiki/Ectrodactyly" title="Ectrodactyly">Ectrodactyly</a></li> <li><a href="/wiki/Brachydactyly" title="Brachydactyly">Brachydactyly</a> <ul><li><a href="/wiki/Stub_thumb" class="mw-redirect" title="Stub thumb">Stub thumb</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">reduction deficits / limb</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Acheiropodia" title="Acheiropodia">Acheiropodia</a></li> <li><a href="/wiki/Ectromelia" title="Ectromelia">Ectromelia</a> <ul><li><a href="/wiki/Phocomelia" title="Phocomelia">Phocomelia</a></li> <li><a href="/wiki/Amelia_(birth_defect)" title="Amelia (birth defect)">Amelia</a></li> <li><a href="/wiki/Hemimelia" title="Hemimelia">Hemimelia</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">multiple joints</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Arthrogryposis" title="Arthrogryposis">Arthrogryposis</a></li> <li><a href="/wiki/Larsen_syndrome" title="Larsen syndrome">Larsen syndrome</a></li> <li><a href="/wiki/RAPADILINO_syndrome" title="RAPADILINO syndrome">RAPADILINO syndrome</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Axial_skeleton" title="Axial skeleton">Axial</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Craniofacial_abnormality" title="Craniofacial abnormality">Skull and face</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Craniosynostosis" title="Craniosynostosis">Craniosynostosis</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Scaphocephaly" title="Scaphocephaly">Scaphocephaly</a></li> <li><a href="/wiki/Oxycephaly" class="mw-redirect" title="Oxycephaly">Oxycephaly</a></li> <li><a href="/wiki/Trigonocephaly" title="Trigonocephaly">Trigonocephaly</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Craniofacial_dysostosis" class="mw-redirect" title="Craniofacial dysostosis">Craniofacial dysostosis</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Crouzon_syndrome" title="Crouzon syndrome">Crouzon syndrome</a></li> <li><a href="/wiki/Hypertelorism" title="Hypertelorism">Hypertelorism</a></li> <li><a href="/wiki/Hallermann%E2%80%93Streiff_syndrome" title="Hallermann–Streiff syndrome">Hallermann–Streiff syndrome</a></li> <li><a href="/wiki/Oto-palato-digital_syndrome" title="Oto-palato-digital syndrome">Oto-palato-digital syndrome</a></li> <li><a href="/wiki/Treacher_Collins_syndrome" title="Treacher Collins syndrome">Treacher Collins syndrome</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">other</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Macrocephaly" title="Macrocephaly">Macrocephaly</a></li> <li><a href="/wiki/Platybasia" title="Platybasia">Platybasia</a></li> <li><a href="/wiki/Craniodiaphyseal_dysplasia" title="Craniodiaphyseal dysplasia">Craniodiaphyseal dysplasia</a></li> <li><a href="/wiki/Dolichocephaly" title="Dolichocephaly">Dolichocephaly</a></li> <li><a href="/wiki/Greig_cephalopolysyndactyly_syndrome" title="Greig cephalopolysyndactyly syndrome">Greig cephalopolysyndactyly syndrome</a></li> <li><a href="/wiki/Plagiocephaly" title="Plagiocephaly">Plagiocephaly</a></li> <li><a href="/wiki/Saddle_nose" title="Saddle nose">Saddle nose</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Vertebral_column" title="Vertebral column">Vertebral column</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Spinal_curvature" class="mw-redirect" title="Spinal curvature">Spinal curvature</a> <ul><li><a href="/wiki/Scoliosis" title="Scoliosis">Scoliosis</a></li></ul></li> <li><a href="/wiki/Klippel%E2%80%93Feil_syndrome" title="Klippel–Feil syndrome">Klippel–Feil syndrome</a></li> <li><a href="/wiki/Spondylolisthesis" title="Spondylolisthesis">Spondylolisthesis</a></li> <li><a href="/wiki/Spina_bifida_occulta" class="mw-redirect" title="Spina bifida occulta">Spina bifida occulta</a></li> <li><a href="/wiki/Sacralization_of_the_fifth_lumbar_vertebra" class="mw-redirect" title="Sacralization of the fifth lumbar vertebra">Sacralization</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Thoracic_skeleton" class="mw-redirect" title="Thoracic skeleton">Thoracic skeleton</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Rib" title="Rib">ribs</a>:</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Cervical_rib" title="Cervical rib">Cervical</a></li> <li><a href="/wiki/Bifid_rib" title="Bifid rib">Bifid</a></li></ul> </div></td></tr><tr><th scope="row" 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