pediatrics
Spina Bifida
Diagnosis of Spina Bifida
Ultrasonography or MRI Spinal cord imaging, with ultrasonography or MRI, is essential in children with occult spinal dysraphism; even children with minimal cutaneous findings may have underlying spinal abnormalities (those with overt defects do not require spinal cord imaging because the anatomy is known). Plain x-rays of the spine, hips, and, if they are malformed, lower extremities, are done. Cranial imaging using ultrasonography, CT, or MRI is done to look for hydrocephalus and syringomyelia. Once the diagnosis of spina bifida is made, urinary tract evaluation is essential and includes urinalysis, urine culture, bloodureanitrogen and creatinine determination, and ultrasonography. Measurement of bladder capacity and pressure at which urine exits into the urethra can determine prognosis and intervention. Need for further testing, such as urodynamics and voiding cystourethrogram, depends on previous findings and associated anomalies. Prenatal screening can be done by doing fetal ultrasonography and by measuring maternal serum levels of alpha-fetoprotein (see Noninvasive Prenatal Fetal Screening Tests ), ideally between 16 weeks and 18 weeks gestation; levels of alpha-fetoprotein can also be measured in amniotic fluid samples if previous testing suggests an increased risk. Elevated levels suggest increased risk of spina bifida cystica (occult spinal dysraphism rarely causes elevated levels). 