**Abstract**

Spina bifida is a common nervous system malformation and it encompasses a wide array of presentations with diverse orthopedic challenges. Manifestations of this disease can include dislocates hips, joint contractures, spine deformity such as scoliosis or kyphosis, clubfeet and limb rotational deformities. Additionally, many of these patients are non-ambulatory and prone to osteoporosis induced pathological fractures. The care of spina bifida patients is a challenging one, requiring many health care professionals from different areas to be working in conjunction. Nowadays, spina bifida patients live longer due to advances in health care and improving the quality of life of these patients is paramount.

**Keywords:** spina bifida, myelomeningocele, orthopedic surgery

## **1. Introduction**

Spina bifida is the most common nervous system malformation. This complex disease can be considered as a group of congenital defects caused by a failure in the closure of the neural tube at the fourth week of the embryonic phase [1]. The true incidence may vary from country to country but overall is at 0.5 per 1000 births [2]. Additionally, gender prevalence is more in girls than in boys, but again it varies geographically [3]. There are mainly two categories of spina bifida, open and closed ones. The open types which include meningocele and meningomyelocele have neural tissue exposed and are more severe in terms of symptoms and prognosis [4]. Closed spina bifida or occulta, has no neural tissue exposed and includes from lipomeningocele to just a sinus tract [5]. Majority of these neural tube defects are located at lower levels of the spine, mostly in the lumbar and sacral levels [6]. These defects can be diagnosed prenatally with ultrasound imaging or maternal alpha-feto-protein levels measured on the mother's serum. Patients with spina bifida can often present with neurological deficits, motor or sensory and orthopedic conditions such as joint contractures, spine deformity, clubfeet and hip dislocations among others. The degree of the deficit and the orthopedic presentation are related to the spine level where the defect is present [4].

#### **2. Non-orthopedic health conditions**

Besides the orthopedic associated conditions, these patients can present with several other health problems. The mortality of these patients has decreased throughout the years with enhanced medical care, thus now more attention is driven
