By Dr Jacques Conradie — Neurosurgeon
When people imagine a pediatric neurosurgical ward, they often picture rare and dramatic conditions—complex brain tumours, unusual congenital deformities, or extremely rare syndromes. While these conditions do exist, the reality in many African hospitals is quite different. Walk into most pediatric neurosurgical units across the continent and you will often find wards filled with what doctors call the “bread and butter” of pediatric neurosurgery: spina bifida and hydrocephalus.
Spina bifida, translated from Latin, literally means “split spine.” It is a congenital condition that occurs when a baby’s spine and spinal cord do not develop properly during early pregnancy. Specifically, it results from a problem with the development of the neural tube, the structure in the embryo that eventually forms the brain and spinal cord.
Normally, the neural tube closes within the first four weeks of pregnancy. When this process does not happen completely, parts of the spine may remain open, allowing the spinal cord or its protective coverings to protrude through the back. The result is a group of conditions collectively known as spina bifida, which can vary greatly in severity.
Different Forms of Spina Bifida
Not all cases of spina bifida look the same. Some forms are mild and may go unnoticed for many years, while others are severe and require urgent medical treatment soon after birth.
The mildest form is spina bifida occulta. In these cases, the bones of the spine do not form completely, but the spinal cord remains inside the body and the skin over the back is intact. Many people with this form may have no symptoms at all and only discover it incidentally later in life.
More severe forms include meningocele and myelomeningocele. In meningocele, the protective membranes surrounding the spinal cord bulge through the opening in the spine. The most serious form, myelomeningocele, occurs when both the spinal cord and its membranes protrude through the defect in the back.
Children born with myelomeningocele often face significant health challenges. These can include weakness or paralysis of the legs, difficulty walking, and problems controlling the bladder and bowel. Many children with spina bifida also develop hydrocephalus, a condition where fluid builds up inside the brain and may require further neurosurgical treatment.
The Role of Neurosurgery
Neurosurgeons play a critical role in treating children with spina bifida. In most cases, surgery is performed shortly after birth to close the opening in the spine. This helps protect the exposed nerves and reduces the risk of infection.
However, surgery is often just the beginning of a child’s medical journey. Many children require long-term care from a team of specialists that may include pediatricians, neurosurgeons, orthopedic surgeons, physiotherapists, and urologists. With proper treatment and rehabilitation, many children with spina bifida can grow up to lead active and fulfilling lives.
Spina Bifida in the African Context
Across Africa, spina bifida remains a significant health challenge. Although the exact numbers vary from region to region, research suggests that neural tube defects occur more frequently in many African countries than in parts of the world where strong nutrition programs and prenatal care are widely available.
Several factors contribute to this. In some communities, access to early antenatal care may be limited. Pregnant women may live far from healthcare facilities or may not seek care until later in pregnancy. As a result, opportunities for early detection or prevention can sometimes be missed.
Another challenge is access to specialized neurosurgical services. In some areas, babies with spina bifida are born far from hospitals equipped to perform the necessary surgery. Delays in treatment can increase the risk of infection, nerve damage, and long-term disability. Improving referral systems and access to specialized care remains an important goal for healthcare systems across the continent.
A Condition That Can Often Be Prevented
Despite these challenges, one of the most important facts about spina bifida is that many cases can be prevented. A key factor in prevention is folate, also known as vitamin B9.
Folate is essential for the proper development of the neural tube during the earliest stages of pregnancy. Adequate levels of folate in a mother’s body significantly reduce the risk of neural tube defects such as spina bifida.
The challenge is timing. Because the neural tube closes within the first four weeks of pregnancy—often before a woman even knows she is pregnant—folate needs to be present before conception and during the early weeks of pregnancy.
For this reason, health authorities recommend that all women of childbearing age consume enough folic acid, either through supplements or fortified foods.
The Importance of Folate in Africa
Many countries have introduced programs to increase folate intake in the population. In South Africa, for example, staple foods such as wheat flour and maize meal are fortified with folic acid. This has helped reduce the number of babies born with neural tube defects.
However, fortification alone is not always enough. Women who may become pregnant are generally advised to take a daily folic acid supplement of about 400 micrograms. Women who have previously had a pregnancy affected by a neural tube defect may require higher doses under medical supervision.
Folate can also be found naturally in foods such as leafy green vegetables, beans, lentils, and citrus fruits. Maintaining a balanced diet rich in these foods can help support healthy pregnancies.
Awareness Is Key
One of the biggest challenges in preventing spina bifida is simply awareness. Many women are not aware that folic acid should ideally be taken before pregnancy begins. Increasing public awareness through community health programs, family planning services, and primary healthcare clinics can make a significant difference.
Education about maternal nutrition empowers women to make informed choices that protect both their own health and the health of their future children.
Looking Forward
Pediatric spinal disorders like spina bifida highlight the close connection between neurosurgery, maternal health, and public health policy. In Africa, reducing the burden of these conditions will require a combination of better nutrition, improved access to prenatal care, and stronger neurosurgical services.
While not every case can be prevented, increasing awareness about folate supplementation and maternal health has the potential to significantly reduce the number of children born with this condition.
For those children who are affected, early diagnosis, timely surgery, and coordinated care offer hope. With the right support, many children with spina bifida can overcome challenges and build independent, meaningful lives.