Spina bifida (Latin: "split spine") is a developmental birth defect involving the neural tube: incomplete closure of the embryonic neural tube results in an incompletely formed spinal cord. In addition, the vertebrae overlying the open portion of the spinal cord do not fully form and remain unfused and open. This allows the abnormal portion of the spinal cord to protrude through the opening in the bones. There may or may not be a fluid filled sac surrounding the open spinal cord. Other neural tube defects include anencephaly, a condition in which the portion of the neural tube which will become the cerebrum does not close, and encephalocele, which results when other parts of the brain remain unfused. Image File history File links No higher resolution available. ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // Q00-Q99 - Congenital malformations, deformations and chromosomal abnormalities (Q00-Q07) Congenital malformations of the nervous system (Q00) Anencephaly and similar malformations (Q01) Encephalocele (Q02) Microcephaly (Q03) Congenital hydrocephalus (Q04) Other congenital malformations of brain (Q05) Spina bifida (Q06) Other congenital malformations of spinal cord (Q07) Other congenital malformations of nervous... // Q00-Q99 - Congenital malformations, deformations and chromosomal abnormalities (Q00-Q07) Congenital malformations of the nervous system (Q00) Anencephaly and similar malformations (Q01) Encephalocele (Q02) Microcephaly (Q03) Congenital hydrocephalus (Q04) Other congenital malformations of brain (Q05) Spina bifida (Q06) Other congenital malformations of spinal cord (Q07) Other congenital malformations of nervous... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Mendelian Inheritance in Man project is a database that catalogues all the known diseases with a genetic component, and - when possible - links them to the relevant genes in the human genome. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... Medical Subject Headings (MeSH) is a huge controlled vocabulary (or metadata system) for the purpose of indexing journal articles and books in the life sciences. ... For other uses, see Latin (disambiguation). ... A congenital disorder is a medical condition or defect that is present at or before birth (for example, congenital heart disease). ... In the developing vertebrate nervous system, the neural tube is the precursor of the central nervous system, which comprises the brain and spinal cord. ... For other uses, see Embryo (disambiguation). ... A diagram of a thoracic vertebra. ... This article does not cite any references or sources. ... The telencephalon (IPA: ) is the name for the forebrain, a large region within the brain to which many functions are attributed. ...

Spina bifida malformations fall into three categories: spina bifida occulta, spina bifida cystica (myelomeningocele), and meningocele. The most common location of the malformations is the lumbar and sacral areas of the spinal cord. Myelomeningocele is the most significant form and is that which leads to disability in most affected individuals. The terms spina bifida and myelomeningocele are usually used interchangeably. In anatomy, lumbar is an adjective that means of or pertaining to the abdominal segment of the torso, between the diaphragm and the sacrum (pelvis). ... Sacrum, pelvic surface The sacrum (os sacrum) is a large, triangular bone at the base of the vertebral column and at the upper and back part of the pelvic cavity, where it is inserted like a wedge between the two hip bones. ...

Spina bifida can be surgically closed after birth, but this does not restore normal function to the affected part of the spinal cord and an individual with this condition will have dysfunction of the spinal cord and associated nerves from the point of the open defect and below. Intrauterine surgery for spina bifida has also been performed and the safety and efficacy of this procedure is currently being investigated with an NICHD-funded grant. The incidence of spina bifida can be decreased up to 70 percent when daily folic acid supplements are taken prior to conception. The National Institutes of Health is an institution of the United States government which focuses on medical research. ... Folic acid and folate (the anion form) are forms of the water-soluble Vitamin B9. ... The term conception can refer to more than one meaning: Concept Fertilisation This is a disambiguation page — a navigational aid which lists pages that might otherwise share the same title. ...

Incidence

Spina bifida is one of the most common birth defects, with an average worldwide incidence of 1-2 cases per 1000 births, but certain populations have a significantly greater risk. Incidence is a measure of the risk of developing some new condition within a specified period of time. ...

In the United States, the average incidence is 0.7 per 1000 live births. The incidence is higher on the East Coast than on the West Coast, and higher in whites (1 case per 1000 live births) than in blacks (0.1-0.4 case per 1000 live births). Immigrants from Ireland have a higher incidence of spina bifida than do nonimmigrants.^[1][2]

The highest incidence rates worldwide were found in parts of the British Isles, mainly Ireland and Wales, where 3-4 cases of myelomeningocele per 1000 population have been reported during the 1970s, along with more than six cases of anencephaly (both live births and stillbirths) per 1000 population. The reported overall incidence of myelomeningocele in the British Isles is 2-3.5 cases per 1000 births.^[1][2] Since then, the rate has fallen dramatically with 0.15 per 1000 live births reported in 1998.^[3] This article describes the archipelago in north-western Europe. ... This article is about the country. ... This article or section is in need of attention from an expert on the subject. ...

Parents of children with spina bifida have an increased risk of having a second child with a neural tube defect.^[1][2]

This condition is more likely to appear in females; the cause for this is unknown.

Symptoms and complications

These vary with the extent of the spinal defect, and differ between the subtypes described below.

The most common location of the malformations is the lumbar and sacral areas of the spinal cord. The lumbar nerves control the muscles in the hip, leg, knee and foot, and help to keep the body erect. The sacral nerves control some of the muscles in the feet, bowel and urinary bladder, and the ability to have an erection. Some degree of impairment can be expected in these areas, resulting in varying degrees of paralysis, absence of skin sensation, and poor or absent bowel and/or bladder control, curvature of the spine (scoliosis), depending on the severity and location of the lesion damage on the spine. Although these individuals are rarely mentally retarded, in most cases there are cognitive problems. In anatomy, lumbar is an adjective that means of or pertaining to the abdominal segment of the torso, between the diaphragm and the sacrum (pelvis). ... Sacrum, pelvic surface The sacrum (os sacrum) is a large, triangular bone at the base of the vertebral column and at the upper and back part of the pelvic cavity, where it is inserted like a wedge between the two hip bones. ... The intestine is the portion of the alimentary canal extending from the stomach to the anus and, in humans and other mammals, consists of two segments, the small intestine and the large intestine. ... This article is about the urinary bladder. ... The erection of the penis, clitoris or a nipple is its enlarged and firm state. ... Skin lesions caused by Chickenpox A lesion is any abnormal tissue found on or in an organism, usually damaged by disease or trauma. ... Mental retardation is a term for a pattern of persistently slow learning of basic motor and language skills (milestones) during childhood, and a significantly below-normal global intellectual capacity as an adult. ...

Tethered Spinal Cord syndrome, with symptoms such as lower body pain, leg weakness, incontinence, scoliosis, numbness, is a common problem associated with spina bifida. Indeed, all spina bifida myelomeningocele patients have Tethered Cord on imaging studies such as Magnetic resonance imaging, but not all will develop symptoms. A tethered cord is thought to result from scar tissue which forms following the initial surgery to close the open defect. Symptoms caused by a tethered cord are rare in infancy and early childhood. Once symptoms develop it is important to make the diagnosis early, before permanent damage is done to the spinal cord and nerves. Tethered Spinal Cord Syndrome or Occult Spinal Dysraphism Sequence is a neurological disorder caused by tissue attachments that limit the movement of the spinal cord within the spinal column. ... “MRI” redirects here. ...

According to the Spina Bifida Association of America (SBAA), over 73 percent of people with spina bifida develop an allergy to latex, ranging from mild to life-threatening. The common use of latex in medical facilities makes this a particularly serious concern. The most common approach is to try to avoid development of the allergy by avoiding contact with latex containing products such as examination gloves, catheters, and many of the products used by dentists. Allergy is an abnormal reaction to a substance foreign to the body that is acquired, predictable and rapid. ... This article is about the typesetting system. ... Catheter disassembled In medicine, a catheter is a tube that a health professional may insert into part of the body. ...

Presentation of the different types

Spina bifida occulta

X ray image of Spina bifida occulta in S-1

Occulta is Latin for "hidden." This is one of the mildest forms of spina bifida although the degree of disability can vary depending upon the location of the lesion bone. Image File history File links No higher resolution available. ... Image File history File links No higher resolution available. ... For other uses, see Latin (disambiguation). ...

In occulta there is no opening of the back, but the outer part of some of the vertebrae are not completely closed. The split in the vertebrae is so small that the spinal cord does not protrude. The skin at the site of the lesion may be normal, or it may have some hair growing from it; there may be a dimple in the skin, a lipoma, a dermal sinus or a birthmark. Skin lesions caused by Chickenpox A lesion is any abnormal tissue found on or in an organism, usually damaged by disease or trauma. ... A lipoma is a common, benign tumor composed of fatty tissue. ... Sinus is Latin for bay, pocket, curve or bosom. In anatomy, the term is used in various contexts. ... A birthmark is a blemish on the skin formed before birth. ...

Many people with the mildest form of this type of spina bifida do not even know they have it, or symptoms do not appear until later in life. People with spina bifida occulta may suffer from a tethered cord from (diastematomyelia) or the lipoma in lipomyelomeningocele, when the spinal cord gets trapped below the affected level of the growing spine. This may cause neurological problems of the legs and bladder. Tethered Spinal Cord Syndrome or Occult Spinal Dysraphism Sequence is a neurological disorder caused by tissue attachments that limit the movement of the spinal cord within the spinal column. ...

A systematic review of radiographic research studies found no relationship between spina bifida occulta and back pain.^[4] More recent studies not included in the review support the negative findings.^[5][6][7] A radiograph of a right elbow-joint Radiography is the use of certain types of electromagnetic radiation—usually ionizing—to view objects. ...

However, other studies suggest spina bifida occulta is not always harmless. One study found that among patients with back pain, severity is worse if spina bifida occulta is present.^[8] Another study found that spina bifida occulta may predispose to disk herniation.^[9]

Spina bifida cystica (myelomeningocele)

In this, the most serious form, the unfused portion of the spinal column allows the spinal cord to protrude through an opening in the overlying vertebrae. The meningeal membranes that cover the spinal cord may or may not form a sac enclosing the spinal elements. Superficially, the cyst may resemble an unrelated defect, sacrococcygeal teratoma. Spina bifida with myeloschisis is the most severe form of spina bifida cystica. In this defect, the neural folds fail to meet and fuse leaving the spinal cord open and the involved area represented by a flattened, plate-like mass of nervous tissue with no overlying skin or membrane. The unfused elements of the spinal cord can be surgically closed along with the overlying muscle and skin shortly after birth (see treatment section below). A cyst (soft c, rhymes with list) is a cloed sac having a distinct membrane and division on the nearby tissue. ... Sacrococcygeal teratoma (SCT), a birth defect, is a tumor located at the base of the tailbone (coccyx). ...

The incompletely closed portion of the spinal cord and the nerves which originate at that level of the cord are damaged or not properly developed. As a result, there is usually some degree of paralysis and loss of sensation below the level of the spinal cord defect. Thus, the higher the level of the defect the more severe the associated nerve dysfunction and resultant paralysis. People may have ambulatory problems, loss of sensation, deformities of the hips, knees or feet and loss of muscle tone. Depending on the location of the lesion, intense pain may occur originating in the lower back, and continuing down the leg to the back of the knee. Paralysed redirects here. ...

Most children and adults with this condition experience problems with bowel and bladder control since the nerves which control these functions originate at the lowest part of the spinal cord. This may result in incontinence from neurogenic bladder. Dysfunction of the urinary bladder due to disease of the central or peripheral nervous system pathways involved in the control of micturition. ...

Many individuals with spina bifida will have an associated abnormality of the cerebellum, called the Arnold Chiari II malformation. In affected individuals the back portion of the brain is displaced from the back of the skull down into the upper neck. In approximately 90 percent of the people with myelomeningocele, or hydrocephalus will also occur because the displaced cerebellum interferes with the normal flow of cerebrospinal fluid. The cerebellum (Latin: little brain) is a region of the brain that plays an important role in the integration of sensory perception and motor output. ... Arnold-Chiari malformation, sometimes referred to as Chiari malformation or ACM, is a congenital anomaly of the brain. ... Cerebrospinal fluid (CSF), Liquor cerebrospinalis, is a clear bodily fluid that occupies the subarachnoid space in the brain (the space between the skull and the cerebral cortex—more specifically, between the arachnoid and pia layers of the meninges). ...

The myelomeningocele (or perhaps the scarring due to surgery) tethers the spinal cord to the enveloping vertebra. In some individuals this causes significant traction on the spinal cord and can lead to a worsening of the paralysis, scoliosis, back pain, or worsening bowel and/or bladder function. Tethered Spinal Cord Syndrome or Occult Spinal Dysraphism Sequence is a neurological disorder caused by tissue attachments that limit the movement of the spinal cord within the spinal column. ... The vertebral column seen from the side Different regions (curvatures) of the vertebral column The vertebral column (backbone or spine) is a column of vertebrae situated in the dorsal aspect of the abdomen. ...

Meningocele

The least common form of spina bifida is a posterior meningocele (or meningeal cyst).

In a posterior meningocele, the outer faces of some vertebrae are open (unfused) and the meninges are damaged and pushed out through the opening, appearing as a sac or cyst which contains cerebrospinal fluid. The spinal cord and nerves are not involved and their function is normal. The meninges (singular meninx) are the system of membranes that envelop the central nervous system. ...

In an anterior meningocele, the inner faces of vertebrae are affected and the cyst protrudes into the retroperitoneum or the presacral space. The retroperitoneum (adj. ... In human anatomy, the presacral space is behind the rectum and in front of the coccyx. ...

Apart from spina bifida, causes of meningocele include teratoma and other tumors of the sacrococcyx and of the presacral space, and Currarino syndrome. Usually a meningocele has no negative long-term effects, although there are reports of tethered cord. Look up teratoma in Wiktionary, the free dictionary. ... For malignant tumors specifically, see cancer. ... Sacrococcygeal teratoma (SCT), a birth defect, is a tumor located at the base of the tailbone (coccyx). ... In human anatomy, the presacral space is behind the rectum and in front of the coccyx. ... Currarino syndrome is a condition where the sacrum (the fused vertebrae forming the back of the pelvis) is not formed properly, there is a mass in the presacral space in front of sacrum, and there are malformations of the anus or rectum. ... Tethered Spinal Cord Syndrome or Occult Spinal Dysraphism Sequence is a neurological disorder caused by tissue attachments that limit the movement of the spinal cord within the spinal column. ...

Pathophysiology

Spina bifida is caused by the failure of the neural tube to close during the first month of embryonic development (often before the mother knows she is pregnant). In the developing vertebrate nervous system, the neural tube is the precursor of the central nervous system, which comprises the brain and spinal cord. ... For other uses, see Embryo (disambiguation). ...

Normally the closure of the neural tube occurs around 28 days after fertilization.^[3] However, if something interferes and the tube fails to close properly, a neural tube defect will occur. Medications such as some anticonvulsants, diabetes, having a relative with spina bifida, obesity, and an increased body temperature from fever or external sources such as hot tubs and electric blankets can increase the chances a woman will conceive a baby with a spina bifida. However, most women who give birth to babies with spina bifida have none of these risk factors, and so in spite of much research, it is still unknown what causes the majority of cases. Categories: Biology stubs ... The anticonvulsants, sometimes also called antiepileptics, belong to a diverse group of pharmaceuticals used in prevention of the occurrence of epileptic seizures. ... This article is about the disease that features high blood sugar. ... An analogue medical thermometer showing the temperature of 38. ...

The varying prevalence of spina bifida in different human populations and extensive evidence from mouse strains with spina bifida suggests a genetic basis for the condition. As with other human diseases such as cancer, hypertension and atherosclerosis (coronary artery disease), spina bifida likely results from the interaction of multiple genes and environmental factors. Cancer is a class of diseases or disorders characterized by uncontrolled division of cells and the ability of these to spread, either by direct growth into adjacent tissue through invasion, or by implantation into distant sites by metastasis (where cancer cells are transported through the bloodstream or lymphatic system). ... For other forms of hypertension, see Hypertension (disambiguation). ... For other uses, see Gene (disambiguation). ...

Research has shown that lack of folic acid (folate) is a contributing factor in the pathogenesis of neural tube defects, including spina bifida. Supplementation of the mother's diet with folate can reduce the incidence of neural tube defects by about 70 percent, and can also decrease the severity of these defects when they occur.^[10][11][12] As yet it is unknown how or why folic acid has this effect. Folic acid and folate (the anion form) are forms of the water-soluble Vitamin B9. ...

Spina bifida does not follow direct patterns of heredity like muscular dystrophy or haemophilia. Studies show that a woman who has had one child with a neural tube defects such as spina bifida, have about a three percent risk to have another child with a neural tube defect. This risk can be reduced to about one percent if the woman takes high doses (4 mg/day) of folic acid before and during pregnancy. For the general population, low-dose folic acid supplements are advised (0.4 mg/day). See Heredity (disambiguation) for other meanings. ... Muscular dystrophy refers to a group of genetic, hereditary muscle diseases that cause progressive muscle weakness. ... Haemophilia or hemophilia (from Greek haima blood and philia to love[1]) is the name of a family of hereditary genetic disorders that impair the bodys ability to control blood clotting, or coagulation. ... The neural tube is the embryonal structure that gives rise to the brain and spinal cord. ... The milligram (symbol mg) is an SI unit of mass. ...

Treatment

There is no cure for nerve damage due to spina bifida. To prevent further damage of the nervous tissue and to prevent infection, pediatric neurosurgeons operate to close the opening on the back. During the operation, the spinal cord and its nerve roots are put back inside the spine and covered with meninges. In addition, a shunt may be surgically installed to provide a continuous drain for the cerebrospinal fluid produced in the brain, as happens with hydrocephalus. Shunts most commonly drain into the abdomen. Pediatrics (also spelled paediatrics or pædiatrics) is the branch of medicine that deals with the medical care of infants and children. ... Old German engraving depicting a trepanation, an ancient and still performed neurosurgical procedure Neurosurgery is the surgical discipline focused on treating those central and peripheral nervous system diseases amenable to mechanical intervention. ... The meninges (singular meninx) are the system of membranes that envelop the central nervous system. ... In medicine, a shunt is a device designed to drain excess cerebrospinal fluid from the brain and carry it to other parts of the body. ... For the human abdomen, see human abdomen. ...

Most individuals with myelomeningocele will need periodic evaluations by specialists including orthopedists to check on their bones and muscles, neurosurgeons to evaluate the brain and spinal cord and urologists for the kidneys and bladder. Such care is best begun immediately after birth. Most affected individuals will require braces, crutches, walkers or wheelchairs to maximize their mobility. The higher the level of the spina bifida defect the more severe the paralysis. Thus, those with low levels may need only short leg braces while those with higher levels do best with a wheelchair. Many will need to manage their urinary system with a program of catheterization. They will need to insert a tube into their bladders to drain urine, of which the intervals vary from person to person, and may need medications to improve their dryness. Most will also require some sort of bowel management program.

Clinical trial

Management of Myelomeningocele Study (MOMS)^[13] is a phase III clinical trial to evaluate the safety and efficacy of fetal surgery to close a myelomeningocele. This involves surgically opening the pregnant mother's abdomen and uterus to operate on the fetus. Fetal skin grafts are used to cover the exposed spinal cord, to protect it from further damage caused by prolonged exposure to amniotic fluid. The fetal surgery may decrease some of the damaging effects of the spina bifida, but at some risk to both the fetus and the pregnant woman. In health care, including medicine, a clinical trial (synonyms: clinical studies, research protocols, medical research) is a process in which a medicine or other medical treatment is tested for its safety and effectiveness, often in comparison to existing treatments. ... Open fetal surgery is an invasive form of fetal intervention in the treatment of birth defects where the uterus is opened up for direct surgery on the fetus. ... This article is about female reproductive anatomy. ... For other uses, see Fetus (disambiguation). ...

Prevention

There is no single cause of spina bifida nor any known way to prevent it entirely. However, dietary supplementation with folic acid has been shown to be helpful in preventing spina bifida (see above). Sources of folic acid include: whole grains, fortified breakfast cereals, dried beans, leaf vegetables and fruits.^[14] This article or section does not cite its references or sources. ... This article does not cite any references or sources. ... Green beans Bean is a common name for large plant seeds of several genera of Fabaceae (formerly Leguminosae) used for food or feed. ... Fresh Swiss chard Fresh water spinach Creamed spinach Steamed kale Leaf vegetables, also called potherbs, greens, or leafy greens, are plant leaves eaten as a vegetable, sometimes accompanied by tender petioles and shoots. ... For other uses, see Fruit (disambiguation). ...

Folate fortification of enriched grain products has been mandatory in the United States since 1998. The FDA and UK recommended amount of folic acid for women of childbearing age and women planning to become pregnant is at least 0.4 mg/day of folic acid from at least three months before conception, and continued for the first 12 weeks of pregnancy.^[15] Women who have already had a baby with spina bifida or other type of neural tube defect, or are taking anticonvulsant medication should take a higher dose of 4–5 mg/day.^[15] The United States Food and Drug Administration is the government agency responsible for regulating food, dietary supplements, drugs, cosmetics, medical devices, biologics and blood products in the United States. ... The term conception can refer to more than one meaning: Concept Fertilisation This is a disambiguation page — a navigational aid which lists pages that might otherwise share the same title. ... The anticonvulsants, sometimes also called antiepileptics, belong to a diverse group of pharmaceuticals used in prevention of the occurrence of epileptic seizures. ...

As of 2007, research has shown that there is a specific gene that causes spina bifida, allowing parents to identify embryos that may develop the condition. ^[16] 2007 is a common year starting on Monday of the Gregorian calendar. ... For other uses, see Embryo (disambiguation). ...

Pregnancy screening

Neural tube defects can usually be detected during pregnancy by testing the mother's blood (AFP screening) or a detailed fetal ultrasound. Spina bifida may be associated with other malformations as in dysmorphic syndromes, often resulting in spontaneous miscarriage. However, in the majority of cases spina bifida is an isolated malformation. Alpha-fetoprotein screening, also called AFP screening, triple test, and expanded AFP screening, is a screening blood test usually offered between 15-20 weeks of pregnancy. ... For other uses, see Ultrasound (disambiguation). ... Miscarriage or spontaneous abortion is the natural or spontaneous end of a pregnancy at a stage where the embryo or the fetus is incapable of surviving, generally defined in humans at a gestation of prior to 20 weeks. ...

Genetic counseling and further genetic testing, such as amniocentesis, may be offered during the pregnancy as some neural tube defects are associated with genetic disorders such as trisomy 18. Ultrasound screening for spina bifida is partly responsible for the decline in new cases, because many pregnancies are terminated out of fear that a newborn might have a poor future quality of life. With modern medical care, the quality of life of patients has greatly improved.^[3] Genetic counseling is the process by which patients or relatives, at risk of an inherited disorder, are advised of the consequences and nature of the disorder, the probability of developing or transmitting it, and the options open to them in management and family planning in order to prevent, avoid or... Genetic testing allows the genetic diagnosis of vulnerabilities to inherited diseases, and can also be used to determine a persons ancestry. ... Amniocentesis (also referred to as amniotic fluid test or AFT), is a medical procedure used in prenatal diagnosis of genetic risk factors, in which a small amount of amniotic fluid, which contains fetal tissues, is extracted from the amnion or amniotic sac surrounding a developing fetus, and the fetal DNA... Edwards Syndrome is the second most common trisomy after Downs Syndrome. ... The well-being or quality of life of a population is an important concern in economics and political science. ...

Notable people

People of note born with spina bifida:

• Jean Driscoll^[17], Olympian and eight-time Boston Marathon winner
• Tanni Grey-Thompson, Welsh Paralympian
• Lawrence Gwozdz, U.S. saxophonist
• Blaine Harrison, of the British band Mystery Jets
• Rene Kirby, U.S. actor in films such as Shallow Hal and Stuck on You^[18]
• John Mellencamp, U.S. rock and roll musician ^{[citation needed]}
• Bobby Steele, U.S. punk rock guitarist and songwriter
• Jeffrey Tate, British conductor
• Hank Williams, U.S. country music singer
• Justin Yoder, American soap box racer
• Mighty Mike McGee, American 2006 World Slam Poetry Champion
• James Connelly, U.S. Paralympian, 2006 Bronze Medal Winner; Sled Hockey
• Aaron Fotheringham, US Wheelchair skateboarder
• Ruben Melendez, jazz and blues musician
• Robert M. Hensel American poet and World record holder

The five Olympic rings were designed in 1913, adopted in 1914 and debuted at the Games at Antwerp, 1920. ... The 100th running of the Boston Marathon, 1996 The Boston Marathon is an annual marathon sporting event hosted by the city of Boston, Massachusetts, on Patriots Day, the third Monday of April. ... Dame Tanni Grey-Thompson DBE (born 26 July 1969) is a Welsh athlete and TV presenter. ... This article is about the country. ... Silver 2004 The Paralympic Games are an official equivalent of the Olympics for athletes with physical disabilities. ... Lawrence S. Gwozdz (born April 1, 1953) is an internationally renowned American saxophonist in the classical tradition. ... Mystery Jets are an English five-piece band based on Eel Pie Island in Twickenham, London. ... Rene Kirby (born February 27, 1955) is an American film and television actor who hails from Burlington, Vermont. ... Shallow Hal is a 2001 romantic comedy film starring Gwyneth Paltrow, Jack Black and Jason Alexander. ... This article is about the song stuck on you. For the article about the comedy film featuring cojoined twins, see Stuck on You (2003 film). ... John Mellencamp, also known as John Cougar and John Cougar Mellencamp, (born October 7, 1951) is best known for being an American rock singer-songwriter. ... Bobby Steele (born March 18, 1956) was the guitarist for Parrotox, Slash and The Whorelords before joining The Misfits in 1978. ... Punk rock is an anti-establishment music movement beginning around 1976 (although precursors can be found several years earlier), exemplified and popularised by The Ramones, the Sex Pistols, The Clash and The Damned. ... Jeffrey Tate (born April 28, 1943, Salisbury) is a prominent English conductor. ... For other persons named Hank Williams, see Hank Williams (disambiguation). ... country music, see Country music (disambiguation) Country music, the first half of Billboards country and western music category, is a blend of popular musical forms originally found in the Southern United States and the Appalachian Mountains. ... Justin Ross Yoder (b. ... 1984 Augusta, Georgia Champion An official Soap Box Derby racer from 1967 Senior Seifenkiste - Deutsches Seifenkisten Derby e. ... This article is an autobiography, and may not conform to Wikipedias NPOV policy. ... Flag of the United States U.S. Paralympics sent 56 athletes (45 men and 11 women) to the 2006 Winter Paralympics in Turin, Italy — the largest delegation of any nation. ... The 2006 Winter Paralympic Games, the ninth winter Paralympics, took place in Turin, Italy from 10 to 19 March, 2006. ... Ice Hockey Sledge Sledge hockey is a sport that was designed to allow participants who have a physical disability to play the game of ice hockey. ... Aaron Fotheringham Aaron Fotheringham (born November 8, 1991 in Las Vegas, Nevada) is a wheelchair athlete, or wheelchair skateboarder who performs tricks adapted from skateboarding and BMX. Aaron calls this ‘hardcore sitting’. He is famed for being the first person to successfully perform a back flip [1] in a wheelchair... For other uses, see Jazz (disambiguation). ... Blues music redirects here. ...

References

Jean Driscoll[17], Olympian and eight-time Boston Marathon winner Tanni Grey-Thompson, Welsh Paralympian Lawrence Gwozdz, U.S. saxophonist Blaine Harrison, of the British band Mystery Jets Rene Kirby, U.S. actor in films such as Shallow Hal and Stuck on You[18] John Mellencamp, U.S. rock and roll musician [citation needed] Bobby Steele, U.S. punk rock guitarist and songwriter Jeffrey Tate, British conductor Hank Williams, U.S. country music singer Justin Yoder, American soap box racer Mighty Mike McGee, American 2006 World Slam Poetry Champion James Connelly, U.S. Paralympian, 2006 Bronze Medal Winner; Sled Hockey Aaron Fotheringham, US Wheelchair skateboarder Ruben Melendez, jazz and blues musician Robert M. Hensel American poet and World record holder Peter Singer - Philosopher - Writings on an Ethical Life

See also

• Hydrocephalus
• Valproic acid
• Neural tube defects
• Open fetal surgery
• Pseudomeningocele
• Samuel Armas (an early recipient of open fetal surgery)

Valproic acid (VPA) is a chemical compound that has found clinical use as an anticonvulsant and mood-stabilizing drug, primarily in the treatment of epilepsy and bipolar disorder. ... The neural tube is the embryonal structure that gives rise to the brain and spinal cord. ... Open fetal surgery is an invasive form of fetal intervention in the treatment of birth defects where the uterus is opened up for direct surgery on the fetus. ... A pseudomeningocele is an abnormal collection of cerebrospinal fluid (CSF) that communicates with the CSF space around the brain or spinal cord. ... Samuel Armas is the child who featured in a famous photograph by Michael Clancy as he seemed to grasp his surgeons hand from a hole in his mothers uterus during a spina bifida surgery. ...

External links

• CDC’s National Center on Birth Defects and Developmental Disabilities
• the International Federation for Spina Bifida and Hydrocephalus (IF) - the umbrella organisation for national spina bifida and hydrocephalus organisations
• Association for Spina Bifida and Hydrocephalus
• National Spina Bifida Association
• Spina Bifida Support Forum
• Spina Bifida Association of Cincinnati
• The Management of Myelomeningocele Study (MOMS)
• UCSF Fetal Treatment Center: Myelomeningocele (Spina Bifida)