}October 30, 2021
jDr. Firas Al-Khatib

Cleft annealing process (Spina bifida)

}October 30, 2021
jDr. Firas Al-Khatib

Cleft annealing process (Spina bifida)

Table of Contents

     Spina bifida is one of the common congenital spinal cord defects in children, and it may pose a danger to the child if neglected. It is currently being treated in Turkey by the most skilled doctors.

    What is cracked steel? Spina bifida

    Spina bifida is a Latin word meaning crucifixion or spina bifida in Arabic.
    It is a congenital malformation that results in a defect in the formation and closure of the spinal cord during the embryonic stage.
    Spina bifida occurs when the neural tube fails to close completely during fetal life, resulting in incomplete formation of the spinal cord and its closure with the structures that protect it (the vertebrae), leaving part of the spinal cord and nerves exposed and at risk of external injury.

     This malformation is most commonly seen in newborns, affecting one in every 2,500 births worldwide.

    slotted steel

    slotted steel


    Types of slotted steel



    The most dangerous and most important type of cleft malformation in which a section of the spinal cord and nerves migrate through the hole in the back of the child is seen in the form of a cyst in the back of the child. This cyst contains cerebrospinal fluid and part of the spinal cord and nerves. Neurological damage that may cause moderate to severe disabilities in a child that is irreversible.



    In this pattern, the membranes (meninges) and cerebrospinal fluid migrate through the opening to the back of the child in the form of a cyst, but in this pattern the spinal cord and spinal nerves do not migrate to the cyst, this pattern is less dangerous than myelomeningocele because the spinal cord and nerves do not migrate to the cyst .


    Hidden Slotted Steel Spina Bifida Occulta

    The least dangerous and most common type among the types is called the hidden or hidden because it is often not asymptomatic and its diagnosis rarely appears in the late childhood stages, and the diagnosis is often made by chance when an image is taken for other reasons.
    In this pattern, two or more vertebrae are not fused, and a small opening is formed through which the meninges or the spinal cord do not cross, and the skin is normal on the child's back (there is no cyst).

    slotted steel

    Types of slotted steel


    Symptoms of cleft steel

    It may cause a range of symptoms and associated complications, including:

    • Difficulty walking in a child
    • problems with the ability to bladder control and intestines
    • Club foot deformities
    • Loss of feeling in the lower extremity
    • Usually some children have breathing problems
    • Lower extremity paralysis
    • Myelomeningocele is almost always associated with another malformation called Arnold Chiari
    • This abnormality causes fluid to accumulate in the brain and occur hydrocephalus hydrocephalus
    slotted steel

    Child with cleft malformation

    Diagnosis of cleft steel


    Diagnosis during pregnancy

    NSfor blood tests

    The titer of alpha-fetoprotein (AFP) is checked, which is a protein produced by the fetus and part of it crosses the mother’s blood through the placenta.

    The eco

    It is the best test for diagnosing spina bifida in the fetus before birth. The examiner can see spina bifida during the second trimester (18 to 24 weeks) of pregnancy.

    amniotic fluid biopsy

    In the event that the examining doctor suspects that the child has cleft lip, he will request a biopsy of the amniotic fluid in order to be sure, but the possible complications of the biopsy cannot be ignored, such as the possibility of a miscarriage, so there are More advanced tests To detect fetal abnormalities.


    Diagnosis after birth

    In some cases, spina bifida is not diagnosed until after the child is born, where a hairy area or something like a birthmark is noticed on the child's back, so the doctor requests an X-ray of the spine or an MRI of the spinal cord and determines the injury or not.

    cleft steel treatment

    In the case of myelomeningocele, surgery should be done as soon as possible to cover the nerves and spinal cord and prevent nerve damage as much as possible.
    Currently, surgery is performed on the fetus while it is in its mother's womb before birth, for fear of the effect of the amniotic fluid on the fetus and the occurrence of spinal cord injury.


    Prenatal surgery

    After the fetal cleft is diagnosed, it is determined whether the mother is a candidate for this type of surgery. The doctors perform the surgery by making a horizontal incision in the mother’s abdomen, and then the ultrasound is used to get a clear view of the location of the fetus and determine the location of the defect, and then an incision is made in the uterus to reach the The fetus is back, and then the defect is repaired by removing the cyst, if any, and closing the opening in the back with the surrounding tissue.
    This complex surgery actually has risks to the life of both the baby and the mother, as a rupture of the mother's uterus can lead to a miscarriage in the fetus.

    This process requires the cooperation of doctors from different specialties and extreme precision in centers equipped for this type of operation.


    Postnatal surgery

    The baby is born naturally at the time of birth and is then placed in the neonatal care unit for evaluation.
    Examinations of the child and an MRI may be ordered to assess cleft malformation.
    The surgery is often performed during the first or second day of birth, as the opening in the baby's back is closed with surrounding tissue and skin under general anaesthesia.
    After surgery, the baby is returned to the neonatal intensive care unit for evaluation.
    Usually the child stays in the hospital for about one to three weeks after surgery for observation.
    In fact, this operation is less dangerous than the operation performed before birth.
    However, one of the risks of this procedure is the risk of damage to the spinal cord nerves by the amniotic fluid during pregnancy.

    Cleft palates are currently treated in Turkey by a team of doctors in specialized surgical centers equipped with the latest technologies and at a low cost compared to other countries, which makes Turkey a leader in the field Medical Tourism In the world, not only because of the low costs, but also because of the presence of the latest hospitals equipped with advanced medical technologies and a distinguished medical team that has succeeded in performing this type of operation a large number of times.


    Complications treatment


    hydrocephalus treatment

    Severe fluid buildup can cause high pressure in the brain, leading to brain problems and disabilities that can be fatal.
    The child needs an operation to drain the fluid. The doctor places a shunt from the brain to the abdomen to drain the fluid.
    The shunt is replaced if it becomes blocked or when the child grows, we need a new shunt that is longer than the old shunt.

    the physical treatment

    Physiotherapy is an important way to help the legs move in steel-cleft patients to live their lives independently, meaning that they do not need the support of medical devices such as a wheelchair.
    The primary goal behind the physical treatment It is to prevent the development of muscular weakness that affects children.


    Treatment of bladder and bowel problems

    that incontinence Constipation is a common symptom in children with cleft palates. We can help these patients by giving medications that help relax the bladder in order to store a larger amount of urine, or a process can be performed to expand the bladder to relieve the suffering of children and their families. To treat constipation, laxatives can be given to help empty the intestines.


    Risk factors for spina bifida


    Folic acid (vitamin B-9) deficiency:  According to studies Folic acid deficiency can increase the risk of various neurological abnormalities, whether at the level of the brain or spine, as it is necessary for the development of the neural tube in the fetus.

    Having a previous family history of neural tube defects:  The risk of infection in the next baby increases in the case of a previous pregnancy with cleft lip.

     Medicines taken during pregnancy: Some medications that a pregnant woman takes may increase the risk of her fetus developing neural tube defects, such as medications taken for epilepsy (carbamazepine and valproic acid), so the pregnant woman should consult the doctor about medications taken during pregnancy and replace these medications with safe medications during pregnancy.

    For a pregnant woman with uncontrolled diabetes: The risk of infection in the fetus increases when pregnant with uncontrolled diabetes.

    Obesity: The risk of developing neural tube defects increases in women with with obesity where (body mass index < 30 BMI).


    The main step for prevention is folic acid, which is important to avoid neural tube defects, as it is given to the pregnant woman at a dose of 400 micrograms, and the woman who is planning to have a child must be drawn to the necessity of taking the drug throughout pregnancy while eating a healthy diet that contains folic.
    A woman who had a previous fetus with spina bifida or any of the neural tube diseases should take folic acid in double doses due to the increased risk of infection for the future fetus.
    Some foods rich in folic acid such as vegetables, fruits, egg yolks, rice and grain products.


    Frequently Asked Questions About Slotted Steel

    What are the most dangerous complications of cleft steel?

    One of the serious complications of cleft palsy patients is paralysis of the lower extremities or meningitis, and in some cases, fluid accumulation in the brain and hydrocephalus occurs.

    Does cleft steel cause premature death?

    In fact, cleft steel by itself does not cause early death to the injured, but the serious complications that occur can cause sudden death of the patient.

    What increases the risk of fetal cleft palsy?

    Failure of the pregnant mother to take folic acid (vitamin B9) increases the risk of the fetus developing spina bifida, according to studies, and pregnant women with diabetes and obesity are all risk factors for spina bifida

    How is cleft palsy treated?

    In fact, there is no cure for the spina bifida patient, but there are ways to manage the disease and prevent complications, such as surgery to protect the spina bifida section of the spinal cord.

    How long does it take to recover from the cleft annealing process?

    After the surgery, the child stays for about 4 to 5 days in the hospital to recover and be monitored by doctors

    Does cleft steel cause mental retardation?

    Cleft palates can cause mental retardation if fluid accumulates within the cranium and high tension within the brain may cause severe consequences for the child, so the fluid must be drained quickly

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