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Myelomeningocele is a severe form of spina bifida that is present at birth. It refers to a defect in the development of the neural tube, a precursor to the spinal cord. The spinal cord never fully forms, and a collection of excess spinal fluid, nerve tissue, membranes, and bone bunch together at the base of the back. An infant born with myelomeningocele can experience leg paralysis, limited sensory abilities, and a lack of control over bladder and bowel functioning. Doctors usually decide to conduct emergency surgery to correct the deformity, and people with myelomeningocele must often receive medical treatments and engage in physical therapy throughout their lives.
The neural tube prompts the development of the spinal cord and brain in healthy fetuses. The maturing spinal cord is normally enclosed within membranes called meninges, which protect and cushion long nerves. In the case of myelomeningocele, the base of the neural tube never fully closes. Meninges, nerves, and vertebra at the lower back protrude outward in a fluid-filled, skin-covered sac. If the skin breaks, the deformity might appear as a large, open lesion. The causes of myelomeningocele are largely unknown, though obesity, diabetes, and drug use in pregnant women are significant risk factors.
Since major nerves are affected, babies with myelomeningocele usually lack sensory perception and control over their bladders and bowels. Some infants are paralyzed from the waist down, and many have limited cognitive functioning. When doctors recognize the condition, they usually perform immediate surgery to drain the excess fluid and attempt to close off the exposed neural tube. Specialists carefully monitor an infant's condition for several weeks, providing intravenous fluids and antibiotics as necessary. In many cases, skilled doctors are able to preserve nerve fibers and allow the infant to gain feeling in the legs.
Children living with myelomeningocele often face many developmental problems. The deformity can cause weakened or misshapen hips and legs, and they may have limited walking and running ability. Physical therapy can help children learn how to control motor skills and strengthen their legs. Speech and cognitive therapy are also needed when the disorder causes brain damage. Medications for pain, swelling, and inflammation are commonly prescribed to limit physiological symptoms.
As children grow up, they may need to wear supportive back braces to encourage proper development of their spines. They usually need regular checkups at doctors' offices and specialty clinics to monitor their cognitive and physical development. Careful management of their conditions and ongoing rehabilitation therapy can help individuals with myelomeningocele learn how to live independently and enjoy many different activities.