From the Guidelines
Spina bifida in a 34-year-old requires comprehensive management focused on addressing specific complications and maintaining function, with a multidisciplinary team approach including neurology, urology, orthopedics, and rehabilitation medicine. The management of spina bifida in adults is complex and requires ongoing care to prevent complications and maintain quality of life 1.
Key Considerations
- Regular follow-up with a multidisciplinary team is essential to address specific complications and maintain function.
- For urinary issues, clean intermittent catheterization (CIC) may be necessary 4-6 times daily, with anticholinergics like oxybutynin (5mg 2-3 times daily) or tolterodine (2-4mg daily) for neurogenic bladder.
- Bowel management typically includes a high-fiber diet, adequate hydration, and possibly medications like polyethylene glycol (17g daily) or bisacodyl suppositories as needed.
- Pain management may require gabapentin (300-1200mg daily in divided doses) for neuropathic pain or standard analgesics for musculoskeletal pain.
- Mobility aids should be optimized, and regular physical therapy is important to maintain strength and prevent contractures.
- Adults with spina bifida need monitoring for progressive issues like tethered cord syndrome, syringomyelia, or Chiari malformation.
- Additionally, regular screening for depression and anxiety is important, as these conditions are common in adults with chronic conditions.
- Annual assessment of kidney function with ultrasound and laboratory tests is crucial to detect early signs of renal deterioration.
Management Approach
The goal of management is to prevent complications, maintain function, and improve quality of life. A comprehensive approach that addresses the complex, lifelong nature of spina bifida is essential. This includes regular follow-up with a multidisciplinary team, management of urinary and bowel issues, pain management, optimization of mobility aids, and regular physical therapy.
Evidence-Based Recommendations
The evidence suggests that a multidisciplinary team approach is essential for the management of spina bifida in adults 1. The use of CIC and anticholinergics for urinary issues, and a high-fiber diet and medications for bowel management, are also supported by the evidence. Pain management with gabapentin or standard analgesics, and optimization of mobility aids and regular physical therapy, are also recommended. Regular screening for depression and anxiety, and annual assessment of kidney function, are also important components of management.
From the Research
Spina Bifida Overview
- Spina bifida is a congenital deformity that is frequently seen in infancy, but its effects can be lifelong 2.
- The most clinically significant subtype is myelomeningocele, which is a condition characterized by failure of the lumbosacral spinal neural tube to close during embryonic development 2.
Urodynamic Changes and Treatment
- Neuro-urological problems are highly important for patients with spina bifida in terms of both social and medical aspects 3.
- The most frequent urodynamic changes in patients with spina bifida are hyperactive detrusor activity and detrusor sphincter dyssynergy preoperatively 3.
- Surgical treatment, such as untethering, can improve urodynamic changes and clinical courses in patients with spina bifida 3, 4.
Age and Outcome
- Younger age, particularly less than or equal to 2 years, is a positive prognostic factor for improvement in symptoms after untethering 5.
- The functional outcome is determined by the age at surgery, with younger patients having a higher chance of gaining a favorable outcome 5.
Management and Care
- Early recognition and comprehensive care can improve long-term health, well-being, and quality of life in individuals with spina bifida 6.
- A periodicity schedule can simplify current spina bifida guidelines and make them easier to use for practitioners and families 6.
- Regular follow-up and investigations using electrophysiologic and urodynamic studies are helpful for early detection of subtle symptomatic cord tethering or retethering 5.