Editing Pediatrics: Neuromuscular Disorders of the Lower Urinary Tract (section)

== Spina bifida/Neural Tube Defects (NTDs) ==

* '''Spina bifida refers to the malformation of the vertebral arches and, commonly, malformation of the neural tube.'''
* '''Embryology'''
** '''Formation of the spinal cord and vertebral column begins at ≈18 days of gestation'''
** '''Closure of the canal proceeds in a caudal direction from the cephalad end and is complete by 35 days'''
* Epidemiology
** Worldwide incidence of 0.3-4.5 per 1000 births
* '''Risk Factors (12)'''
*# '''Folate deficiency''' (women with low levels of folic acid and impairment of folate mediated pathways or antibodies to folate)
*# '''Family history of NTDs'''
*# '''Young and advanced maternal age'''
*# '''Maternal obesity'''
*# '''Maternal diabetes'''
*# '''Maternal fever or flu'''
*# '''Maternal caffeine consumption'''
*# '''Specific maternal occupational exposures'''
*# '''Maternal low educational level and socioeconomic status'''
*# '''Maternal passive smoking'''
*# '''Maternal periconceptual stressful event'''
*# '''Low maternal weight gain'''
* '''The term includes'''
*# '''Spina bifida occulta/occult spinal dysraphism''', which involves only a bony (vertebral) arch defect
*# '''Spina bifida cystica''' (aperta), which involves a bony defect and a neural tube (spinal cord) defect
*#* '''Primary subclasses of spina bifida cystica (2):'''
*#*# '''Meningoceles''' (which contain only a herniated meningeal sac with no neural elements)
*#*# '''Myelomeningoceles'''
*#*#* The nerve roots or portions of the spinal cord have evaginated beyond the vertebral bodies
*#*#* '''Accounts for > 90% of spina bifida cystica'''
*#*#* '''Most devastating in terms of sequelae.'''
*#*#* Insert figure