The term “congenital” is a term used to express the problems caused by the disruptions that occur during the developmental stages of the baby during the development of the mother’s womb. The term “congenital developmental defect” or “anomaly” is also used for this type of defective development.
The problems posed by defects in the developmental stages are many and varied. “Spina bifida” is a term used for defects caused by defects seen during the development of the spinal cord within these defects. Different terms are used for other developmental defects. If we take a brief look at the developmental stages of the spinal cord, it will be possible to better understand the subject. While the embryo forming the baby was previously two-layered and approximately 1.5 mm in length, the development of the central nervous tissue begins when the layer rising along a line appearing in the middle of the upper layer of this embryo mutually joins the midline and almost forms a pipe. One end of this tube forms the brain. The other end forms the last end of the spinal cord. If this process, which forms a pipe by merging in the midline, cannot be fully formed and the layers cannot join in the midline, it is called “midline closure defects”. This issue is known as spina bifida among the people, but the main thing is the defect in the closure of the midline.
Although the cause is not known exactly, it is known that having a genetic predisposition facilitates the emergence of such defects. However, when seeking answers to the genetics issue
, it should be noted that this developmental defect is not hereditary. An important condition related to heredity, if there is one baby with myelomenigocele in a family, the risk of having such a second baby increases from 1/1000 to 30/1000, which is the general incidence level. In addition, in our laboratory studies on chicken embryos, it is known that smoking, alcohol, malnutrition from folic acid and some drugs cause such problems. There is no known direct link between consanguineous marriage and spina bifida. However, if two people with spinabifida get married, the probability of having such a baby will increase, so it will be necessary to monitor the pregnancy very carefully. It is now widely known that supplementing with “folic acid” helps prevent these types of defects from occurring. Folic acid supplementation is 72% helpful in overcoming such problems if it is started and continued “before” pregnancy. A good ultrasound follow-up during pregnancy is very important.
There are midline closure defects at multiple levels (which can be classified as severe or mild). The most severe is a condition called myelomeningocele, in which the spinal cord develops almost at all. The closer it is to the coccyx, the less damage and neurological defect, and this can be interpreted as the baby’s chance. The neurological picture is very severe in defects at higher (near the head) levels, and there is a situation where the baby’s feet do not move at all. Surgical intervention is required to relieve spinal cord tension in cases of occult spina bifida that do not show external symptoms.
Since the brain and spinal cord are in the same sac, babies with open spina bifida need to be operated on without delay and the defect should be corrected in a timely manner, due to the danger of meningitis by catching germs from it, while those with closed spinal cords have tense spinal cords. We can perform surgery without burdening the patient with a mild neurological picture, and with the intensive rehabilitation work to be done later, the patients can continue their normal lives.
