Incidence of undetected spina bifida occulta in patients presenting for other neurosurgical conditions in the emergency room of a tertiary health facility

Abstract

Background: Spina bifida occulta are the most common spinal dysraphisms, yet, the least diagnosed. It is estimated that as much as 30–50% of normal healthy people could harbour this defect.
Objectives: To evaluate the incidence of spina bifida occulta and tell-tale signs amongst consecutive patients presenting to a tertiary health facility, under emergency conditions, who had no previously known congenital spinal dysraphisms.
Methodology: The study was conducted at the Accident and Emergency Room of Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi, Anambra State, Nigeria over a 12-month period. The cohort of patients at the Emergency Room were preferred, in order to reduce the interference from overt dysraphisms. Consecutively, consenting patients, were recruited, and data were presented in charts, tables and graphs, and analysed by comparative evaluations with literature.
Results: There were 109 recruited subjects, within the age range of 9 to 85years, and most were males 80 (73.4%). Occult dysraphisms were detected in 8 (7.34%) of cases, 6 (5.5%) of whom were males. The affected spinal regions were: cervical 1 (0.92%), thoracic 1 (0.92%), lumbar 5 (4.6%) and sacral 1 (0.92%); a pre-morbid deficit of unilateral foot drop was found in 2 (1.83%). At presentation, most of the subjects came with neurological deficits; however, their dysraphisms were only discovered at routine imaging. There was no family history of spinal dysraphism amongst them. The tell-tale signs were abnormal hair growth 7 (6.42%), and dermal sinus 1 (0.92%). Spinal magnetic resonance imaging (MRI) and computed tomography (CT) were each employed for 2 (1.83%) cases, respectively.
Conclusion: Occult spinal dysraphisms were discovered in 7.3% of our emergency patients, and most had abnormal bands of hair growth. The non-diagnoses of these cases by relatives and healthcare personnel, prior to their presentation, calls for concern.