NHS hospital management by overseas firms 'discussed'

MPs are due to debate the health bill this week

NHS shake-up

Senior officials have discussed handing the management of up to 20 English NHS hospitals to overseas companies, emails released by the government indicate.

Talks included plans for 10 to 20 hospitals but starting with one hospital at a time, the Observer says.
It comes as Lib Dem peer Shirley Williams said she had "huge concerns" over the NHS reform plans.
Health Secretary Andrew Lansley says claims the government aims to privatise the NHS are "ludicrous scaremongering".
The emails were released after a Freedom of Information request by non-profit investigations organisation Spinwatch, which monitors public relations and spin.
They are reported to show that consulting firm McKinsey was acting as a broker between the Department of Health and "international players" for contracts worth hundreds of millions of pounds.
One email talks about "interest in new solution for 10-20 hospitals but starting from a mindset of one at a time with various political constraints".
The Observer reported that the "international hospital provider groups" would want certain conditions regarding taking over the hospitals, such as "a free hand on staff management", but that the NHS would be allowed to "keep real estate and pensions".

---

In any market, there is always a rump of organisations that struggle. The NHS is no different - and for the past 20 years successive governments have been wondering what to do with them.
The 10-20 figure represents less than a tenth of trusts. They tend to be the most badly run, attract the least patients and have the largest debts. If they were private sector groups they would simply shrivel and die.
But the natural reaction of the NHS is to look at new ways of running them. This can involve parachuting in NHS managers from top-performing hospitals, mergers with larger organisations or - as these emails show - bringing in the private sector.
This model has already been proposed for one hospital - Hinchingbrooke in Cambridgeshire. Under the plans, private managers will run the trust but the services will remain NHS.
However, there is a growing consensus that there needs to be a more brutal approach - the closure of some units.

The Department of Health said it was not unusual to hold meetings with external organisations and that NHS staff and assets would always remain wholly owned by the NHS.

The government is in the process of trying to overhaul the way the NHS in England works, giving GPs and other clinicians much more responsibility for spending and encouraging greater competition with the private sector.
The controversial plans have been labelled some of the most radical in the history of the health service.
Legal duty
Mr Lansley said: "The reality is that we're giving more power and choice to patients over how they get treated, keeping waiting times low and cutting bureaucracy so more cash gets to the front line.
"We will not allow these lies to block the progress we want to achieve for patients."
The government's plans were put on hold in the spring after criticisms from MPs and health unions. A series of concessions to the Health and Social Care Bill were proposed and MPs will debate the legislation this week.
Meanwhile, Lady Williams said the battle over bill was "far from over" and the reforms "need not mean upheaval and disintegration".
'Flawed US system'
Writing in the Observer, she said: "The central issue is whether, if the bill is passed without further amendment, there will be any legal duty... to provide and secure a comprehensive health service for the people of England, free at the point of need - the heart of what the NHS is all about."
She added: "I am not against a private element in the NHS, which may bring innovation and good practice, provided it is within the framework of a public service - complementary but not wrecking.
"But why have they been bewitched by a flawed US system?"
Her comments follow renewed demonstrations against the reforms this weekend by health workers across England.
Candlelit vigils and protests were held in areas including London, Reading, Cambridge, Norwich, Sunderland, Manchester, Brighton, Leeds and Portsmouth.
Christina McAnea, head of health at the union Unison, said: "People are rightly proud of an NHS that puts patient need before private profit, and voting through this Bill will be the end of the NHS as we know it."

UN more worried about its logo than human rights abuse 26 August

A Totobiegosode woman after she was forced out of the forest, Paraguayan Chaco. © Ruedi Suter/Survival

STOP PRESS

August 31st, 2011

Yaguarete has now reinstated the UN Global Compact logo on its website.

++++++++++++++++++++

Ayoreo Indians in Paraguay have been left amazed by the UN’s reaction to a formal complaint they issued against cattle ranching company Yaguarete Pora.

In May, Ayoreo leaders issued a formal complaint against the company’s involvement in the UN Global Compact, an initiative allegedly designed to encourage businesses to comply with environmental and human rights principles.

The Ayoreo pointed out that the company has been found guilty of illegally clearing forest in their ancestral territory and withholding evidence proving that uncontacted Ayoreo Indians are living there.

The UN’s response to the Indians’ request that it remove the company from the initiative stated, ‘We have neither the resources nor the mandate to conduct investigations into any of our participants.’

But now the UN has written to Yaguarete. However, far from taking issue with its human rights abuses, the UN complained that Yaguarete was displaying its logo without having filled in the necessary form, and asked it to remove the logo from its website.

Now you see it........................................................ Now you don't © Survival

The Global Compact logo immediately disappeared from the company’s website.

Uncontacted Indians could be wiped out if the cattle ranchers continue to destroy the forest on which the Indians depend for their surviva
l

Brazil Kaxinawa Indian 'may be world's oldest woman'

If Maria's birth certificate is right, she is nearly six years older than the verified oldest living woman

A Brazilian Indian who celebrates her birthday on Saturday may be the oldest woman in the world - and by some distance.

Maria Lucimar Pereira, a member of the Kaxinawa tribe, is 121 years old, says a tribal rights group.
It says she has a birth certificate showing she was born in 1890.
But the Guinness Book of Records says she has not been registered with them. The verified oldest living woman is 115-year-old American Besse Cooper.
Maria puts her longevity down to a healthy lifestyle, Survival International said - with regular dishes including grilled meat, monkey, fish, the root vegetable manioc and banana porridge, and no salt, sugar or processed foods.
She has never lived in a city and does not speak Portuguese, only the language of her tribe, the Kaxinawa, which inhabits Brazil's western Amazon and eastern Peru.
She remains physically active, community leader Carlos told Survival - walking around the village telling stories and visiting grandchildren in neighbouring areas.

Maria says she will spend her birthday with her family

Maria says she will spend her birthday with her family.
The pictures of Maria were taken by employees of the INSS - the national social security institute - when she responded to a request, broadcast on public radio, to appear at the regional INSS office, Brazilian media reported.
Brazilians over the age of 110 are asked to visit their local offices to prove that they are still alive in order to receive pensions or other benefits.
Troubles
Guinness World Records told the BBC it had no record of contact from Maria Lucimar Pereira or anyone on her behalf. It said the oldest verified living person remained Besse Cooper.
"We would be very interested in hearing from anyone who believes they are older than this [and] can provide documentary evidence," the company's Damian Field said.
Survival says her birth certificate, which it has a copy of, was issued in 1985.
It paints a picture of the troubles Maria may have lived through, such as the rubber boom which saw many Indians enslaved and killed.
"All too often we witness the negative effects forced change can have on indigenous peoples," Survival director Stephen Corry said.
"It is refreshing to see a community that has retained strong links to its ancestral land and enjoyed the undeniable benefits of this."

Journal editor resigns over 'problematic' climate paper

The paper claimed mainstream climate models misunderstood the role of clouds

• 
  

The editor of a science journal has resigned after admitting that a recent paper casting doubt on man-made climate change should not have been published.

The paper, by US scientists Roy Spencer and William Braswell, claimed that computer models of climate inflated projections of temperature increase.
It was seized on by "sceptic" bloggers, but attacked by mainstream scientists.
Wolfgang Wagner, editor of Remote Sensing journal, says he agrees with their criticisms and is stepping down.

I stand behind the science contained in the paper”

End Quote Dr Roy Spencer University of Alabama

"Peer-reviewed journals are a pillar of modern science," he writes in a resignation note published in Remote Sensing.

"Their aim is to achieve highest scientific standards by carrying out a rigorous peer review that is, as a minimum requirement, supposed to be able to identify fundamental methodological errors or false claims.
"Unfortunately, as many climate researchers and engaged observers of the climate change debate pointed out in various internet discussion fora, the paper by Spencer and Braswell... is most likely problematic in both aspects and should therefore not have been published."
Heated debate
The paper became a cause celebre in "sceptical" circles through its claim that mainstream climate models inflated temperature projections through misunderstanding the role of clouds in the climate system and the rate at which the Earth radiated heat into space.
This meant, it said, that projections of temperature rise made in Intergovernmental Panel on Climate Change (IPCC) reports were too high.

Dr Spencer is a committed Christian as well as a professional scientist

The paper, published in July, was swiftly attacked by scientists in the mainstream of climate research.
They also commented on the fact that the paper was not published in a journal that routinely deals with climate change. Remote Sensing's core topic is methods for monitoring aspects of the Earth from space.
Publishing in "off-topic" journals is generally frowned on in scientific circles, partly because editors may lack the specialist knowledge and contacts needed to run a thorough peer review process.
In essence, Dr Wagner, a professor of remote sensing at Vienna University of Technology, is blaming himself for this failing.
But he also blames the researchers themselves for not referencing all the relevant research in their manuscript.
"The problem is that comparable studies published by other authors have already been refuted..., a fact which was ignored by Spencer and Braswell in their paper and, unfortunately, not picked up by the reviewers.
"In other words, the problem I see with the paper... is not that it declared a minority view (which was later unfortunately much exaggerated by the public media) but that it essentially ignored the scientific arguments of its opponents.
"This latter point was missed in the review process, explaining why I perceive this paper to be fundamentally flawed and therefore wrongly accepted by the journal."
'Honourable course'
Scientific papers that turn out to be flawed or fraudulent are usually retracted by the journals that publish them, with editorial resignations a rarity.
But Bob Ward, policy and communications director at the Grantham Research Institute on Climate Change and the Environment at the London School of Economics, said Dr Wagner had done the decent thing.

Nasa's Aqua satellite provides data on clouds, rain, ice and other earth parameters

"It was a mistake, he's owned up to it and taken an honourable course, and I think he's to be commended for it," he told BBC News.
"I think it remains to be seen whether the authors follow a similar course."
Mr Ward described the tactic of publishing in off-topic journals as a "classic tactic" of scientists dismissive of man-made climate change.
"Those who recognise that their ideas are weak but seek to get them into the literature by finding weaknesses in the peer review system are taking a thoroughly disreputable approach," he said.
Roy Spencer, however, told BBC News: "I stand behind the science contained in the paper itself, as well as my comments published on my blog at drroyspencer.com.
"Our university press release necessarily put our scientific results in lay language, and what we believe they mean in the larger context of global warming research. This is commonly done in press statements made by the IPCC and its scientists, too, when reporting on research which advocates the view that climate change is almost entirely caused by humans.
"The very fact that the public has the perception that climate change is man-made, when in fact there is as yet no way to know with any level of scientific certainty how much is man-made versus natural, is evidence of that."
Dr Spencer is one of the team at the University of Alabama in Huntsville that keeps a record of the Earth's temperature as determined from satellite readings.
He is also on the board of directors of the George C Marshall Institute, a right-wing thinktank critical of mainstream climate science, and an advisor to the Cornwall Alliance for the Stewardship of Creation, an evangelical Christian organisation that claims policies to curb climate change "would destroy jobs and impose trillions of dollars in costs" and "could be implemented only by enormous and dangerous expansion of government control over private life".

In hydrocephalus, there is a buildup of fluid

Ventriculoperitoneal shunting

Shunt - ventriculoperitoneal; VP shunt; Shunt revision

Last reviewed: November 22, 2010.

Ventriculoperitoneal shunting is surgery to relieve increased pressure inside the skull due to excess cerebrospinal fluid (CSF) on the brain (hydrocephalus).

This article primarily discusses shunt placement in children.

See also: Intracranial pressure

Description

This procedure is done in the operating room under general anesthesia. It takes about 1 1/2 hours.

The child's hair behind the ear is shaved off. A surgical cut in the shape of a horseshoe (U-shape) is made behind the ear. Another small surgical cut is made in the child's belly.

A small hole is drilled in the skull. A small thin tube called a catheter is passed into a ventricle of the brain.

Another catheter is placed under the skin behind the ear and moved down the neck and chest, and usually into the abdominal (peritoneal) cavity. Sometimes, it goes to the chest area. The doctor may make a small cut in the neck to help position the catheter.

A valve (fluid pump) is placed underneath the skin behind the ear. The valve is attached to both catheters. When extra pressure builds up around the brain, the valve opens, and excess fluid drains out of it into the belly or chest area. This helps decrease intracranial pressure.

The valves in newer shunts can be programmed to drain more or less fluid from the brain.

Why the Procedure Is Performed

In hydrocephalus, there is a buildup of fluid of the brain and spinal cord (cerebrospinal fluid or CSF). This buildup of fluid causes higher than normal pressure on the brain. Too much pressure, or pressure that is present too long, will damage the brain tissue.

A shunt helps to drain the excess fluid and relieve the pressure in the brain. A shunt should be placed as soon as hydrocephalus is diagnosed.

Risks

Risks for any anesthesia are:

• 
  
  

  Reactions to medications




• 
  
  

  Problems breathing




• 
  
  

  Changes in blood pressure or breathing rate

Risks for any surgery are:

• 
  
  

  Bleeding




• 
  
  

  Infection

Possible risks of ventriculoperitoneal shunt placement are:

Blood clot or bleeding in the brain

• 
  
  

  Brain swelling




• 
  
  

  The shunt may stop working and fluid will begin to build up in the brain again.




• 
  
  

  The shunt may become infected.




• 
  
  

  Infection in the brain




• 
  
  

  Damage to brain tissue




• 
  
  

  Seizures

Before the Procedure

If the procedure is not an emergency (planned surgery):

• 
  
  

  Tell your doctor or nurse what drugs, supplements, vitamins, or herbs your child takes.




• 
  
  

  Give any drugs the doctor told you to give your child. It is okay if they take them with a small sip of water.




• 
  
  

  The doctor or nurse will tell you when to arrive at the hospital.

Ask your doctor or nurse about eating and drinking before the surgery. The general guidelines are:

• 
  
  

  Older children should not eat any food or drink any milk for 6 hours before surgery, but they can have clear fluids (juice or water) up until 4 hours before the operation.




• 
  
  

  Infants younger than 12 months can usually eat formula, cereal, or baby food until about 6 hours before surgery. They may have clear fluids up until 4 hours before the operation.

Your doctor may ask you to wash your child with a special soap on the morning of the surgery. Rinse well after using this soap.

After the Procedure

Your child will need to lie flat for 24 hours the first time a shunt placed. After that your child will be helped to sit up.

The usual stay in the hospital is 3 to 4 days.The doctor will check vital signs and neurological status often. Your child may get medication for pain. Intravenous fluids and antibiotics are given. The shunt will be checked to make sure it is working properly.

Outlook (Prognosis)

Shunt placement is usually successful in reducing pressure in the brain. But if hydrocephalus is related to other conditions, such as spina bifida, brain tumor, meningitis, encephalitis, or hemorrhage, these conditions could affect the prognosis. The severity of hydrocephalus present before surgery will also affect the outcome.

Support groups for families of children with hydrocephalus or spina bifida are available in most areas.

The major complications to watch for are an infected shunt and a blocked shunt.

References

1. Etiological categories of neurological disease. In: Goetz CG, ed. Textbook of Clinical Neurology. 3rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 28.



2. Kinsman SL, Johnston MV. Congential anomalies of the central nervous system. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 592.

Review Date: 11/22/2010.

Reviewed by: Kevin Sheth, MD, Department of Neurology, University of Maryland School of Medicine, Baltimore, MD. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Disclaimer

Copyright © 2011, A.D.A.M., Inc

Alisons Story

I wanted to write about my experience of having Jack and being pregnant. I have recently joined ASBAH's forum on Facebook and I realise how many other people with spina bifida are considering becoming a parent and thought it might be useful to share my experience.

I was 37 when, as a woman with spina bifida I became pregnant for the first time. Although it was a lovely surprise I have to admit it was also quite a shock having been told at the age of 20 I was infertile. Hence the pregnancy was unplanned as I had come to a point of acceptance years before that I wouldn't ever be a mum.

So there I was, standing in my bathroom in a state of disbelief staring at my pregnancy test as the word "pregnant" flashed up. I dropped the test stick in the sink and rushed in to my living room pacing the room. It was a mixture of elation and fear flooding through me all at once. Elation that once again the medical profession had got it wrong just like they told my mum I would probably never walk when I was two years old (I walked at 3 1/2). The realisation that I would in fact be a mum after so many years of believing I wouldn't. Then of course the fear. Fear for the baby as I hadn't been taking folic acid and fear for me. How would the pregnancy affect me and how could I physically cope with being a mum.

My pregnancy was full of professionals who although monitored me as a high risk "mum to be" appeared to have no specialist knowledge of spina bifida. Thank God for ASBAH and the medical advisers who I was really able to talk to and discuss and prepare myself for the way ahead.

My pregnancy wasn't easy. I went from walking without aids to being on crutches and barely able to dress myself at the end and other problems related to my disability worsened. Having said that I look back on the experience fondly and still remember the first time my unborn baby kicked me. It was Boxing Day and it was the best Christmas present I could ever have.

At 20 weeks pregnancy came a bit of a blow. My scan showed that my baby had talipes. They had been looking for spina bifida and had ruled it out up to then but since I too have talipes (clubfoot) and it can be associated with spina bifida I was told that they had to suspect that the baby could have some form of spina bifida even though they couldn't see it. Again I was fearful. Having a baby was going to be physically demanding enough for me but having a baby who also had physical problems to deal with seemed overwhelming. From then on I was scanned regularly until 30 weeks.

On 11th June 2008 I gave birth to my beautiful son Jack. He was born by emergency caesarean nearly 2 weeks overdue after I had been induced and he had gone into distress during labour. I have to say that one of the positive aspects of being a spina bifida mum in labour was that pain didn't scare me nor did medical intervention. The big disappointment was that my spina bifida meant that my caesarean had to be performed under general anaesthetic rather than a spinal anaesthetic so I wasn't awake to see him come into the world.

When I woke up I peered across the room to see my partner Michael holding this bundle in his arms. He brought him over to me and the midwife put him straight to my breast. It was love at first sight. I soon discovered why my labour hadn't progressed so well. He weighed in at 8 pound 14 oz and I'm only 4 ft 9 inches tall! My advice to other mums to be in my position is to push for a 36-week scan to estimate the baby’s size. I was offered one but was told it was optional and therefore didn’t have one as I’d had so many during my pregnancy. I think if I'd had one at that point they wouldn't have let me go overdue and the birth would have been a lot less traumatic for all of us whether it had been a planned Caesarean or a pre term vaginal delivery.

Jack started treatment for his clubfoot at 13 days old when he was put in plaster. His foot was gradually straightened using a series of weekly plasters, a small op and the boots and bars. He will have to wear them at night until he is 4 years old.

Jack doesn't have spina bifida. He was 10 weeks old before they finally ruled it out. I was relieved because even though I've achieved everything I have wanted to in life I'm glad he won't have to go through the operations and pain I had to put up with. And when he is 4 years old his foot will be completely corrected.

Caring for Jack through his treatment has been emotionally hard for me. Going to Great Ormond Street, albeit a fantastic hospital, bought back memories of my childhood that I would have rather left behind me. It's also been physically very challenging for me, as Jack is very tall and heavy for his age. My initial reservations about asking for help have subsided and I have managed to get some good support from occupational therapy in looking for equipment that will help me and strategies in helping me to get Jack be a bit more cooperative during change times so he doesn't fight and run away from me but gets rewarded for sitting still. I think though that asking for help has been the hardest aspect of being a new mum as I've fought all my life for maximum independence. You have to remember though that all new mums need help and not feel as though it's the disability getting the better of you.

A positive aspect of being a disabled mum is that I feel I am so much more used to assessing the risks that could be present for Jack. When you have a disability you have to plan ahead when you are going out and know your limitations. These become a way of life for a physically disabled person and they are excellent attributes to have as a mum. Also I've noticed how much of a shock it is to new able-bodied mums: having to think about ramps and access for buggies. Even though I walk independently I'm used to looking for lifts, handrails and ramps so a new pram didn't feel like a new obstacle; in fact it helped me get back on my feet by offering me something to hold on to... The best walking aid ever.... a pram with your new baby in it.

There are days when Jack is having tantrums that he makes me feel very physically inadequate. If he decides to run off and lie down on the ground in a temper there is nothing I can do to stop him. But I think every mum goes through these feelings so I try not to let it get to me. I know that all Jack really needs is love and affection. My disability is as insignificant to him as his foot problems are to me. They are just part of who we are and if anything add to the bond we have with each other.

Alison has spina bifida and is mum to Jack who is 2 years old.

Meningocele repair

Myelomeningocele repair; Myelomeningocele closure; Myelodysplasia repair; Spinal dysraphism repair; Meningomyelocele repair; Neural tube defect repair; Spina bifida repair

Last reviewed: February 9, 2011.

Meningocele repair (also known as myelomeningocele repair) is surgery to repair birth defects of the spine and spinal membranes. Meningocele and myelomeningocele are types of spina bifida.

Description

For both meningoceles and myelomeningoceles, the surgeon will close the opening in the back.
After birth, the defect is covered by a sterile dressing. Your child may then be transferred to a neonatal intensive care unit (NICU) and cared for by a medical team experienced in caring for children with spina bifida.
Your baby will likely have an MRI (magnetic resonance imagining) or ultrasound of the back. An MRI or ultrasound of the brain may be done to look for hydrocephalus (extra fluid in the brain).
If the myelomeningocele is not covered by skin or a membrane when your child is born, surgery will happen within 24 to 48 hours after birth to prevent infection.
If your child has hydrocephalus, the doctor may put a shunt (plastic tube) in their brain to drain the extra fluid to the stomach. This prevents pressure that could damage the baby’s brain. See also: Ventriculoperitoneal shunt
Your child should not be exposed to latex before, during, and after surgery. Many of these children have very bad allergies to latex.

Why the Procedure Is Performed

Repair of a meningocele or myelomeningocele is needed to prevent infection and further injury to the child’s spinal cord and nerves. Surgery cannot correct the defects in the spinal cord or nerves.

Risks

Risks for any anesthesia are:

• Breathing problems
• Reactions to medications

Risks for any surgery are:

• Bleeding
• Infection

Risks for this surgery are:

• Fluid build up and pressure in the brain (hydrocephalus)
• Increased chance of urinary tract infection and bowel problems
• Infection or inflammation of the spinal cord
• Paralysis, weakness, or sensation changes due to loss of nerve function

Before the Procedure

A health care provider often will find these defects before birth using fetal ultrasound. The doctor will follow the fetus very closely until birth. It is better if you're infant is carried to full term. Your doctor will want to do a cesarean section (C-section). This will prevent further damage to the sac or exposed spinal tissue.

After the Procedure

Your child will usually need to spend about 2 weeks in the hospital after surgery. The child must lay flat without touching the wound area. After surgery, your child will receive antibiotics to prevent infection.
MRI or ultrasound of the brain is repeated after surgery to see if hydrocephalus develops once the defect in the back is repaired.
Your child may need physical, occupational, and speech therapy. Many children with these problems have gross (large) and fine (small) motor disabilities, and swallowing problems, early in life.
The child may need to see a team of medical experts in spina bifida often after they are discharged from the hospital.

Outlook (Prognosis)

How well a child does depends on the initial condition of their spinal cord and nerves. After a meningocele repair, children often do very well and have no further brain, nerve, or muscle problems.
Children born with myelomeningocele usually have paralysis or weakness of the muscles below the level of their spine where the defect is. They also may not be able to control their bladder or bowels. They will likely need medical and educational support for many years.
The ability to walk and control bowel and bladder function depends where the birth defect was on the spine. Defects lower down on the spinal cord may have a better outcome.

References

1. Kinsman SL, Johnston MV. Congenital anomalies of the central nervous system. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 592.

Review Date: 2/9/2011.

Reviewed by: Luc Jasmin, MD, PhD, Department of Neurosurgery at Cedars-Sinai Medical Center, Los Angeles, and Department of Anatomy at UCSF, San Francisco, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc

myelomeningocele and this is the type of spina bifida that will be referred to whenever the term spina bifida is used

Introduction

Children with disability

Dr Sheila Shribman talks about how parents and health professionals can work together to support children with disability.

Spina bifida occulta

Spina bifida occulta is the least serious type of spina bifida. In this type of spina bifida, the opening in the spine is very small, with a gap in one or more vertebrae (disc-shaped bones of the spine). The opening in the spine is covered with skin, so the gap is not visible from the outside.

Spina bifida occulta does not usually cause any symptoms and most people are unaware that they have the condition. In such cases, no treatment is required. In other cases, some symptoms may be apparent, such as bladder and bowel problems, or scoliosis, which is an abnormal curvature of the spine.

Spina bifida meningocele

Spina bifida meningocele is the rarest type of spina bifida. In this type of spina bifida, the meninges, which are the protective membranes that surround the spinal cord, are pushed out between openings in the vertebrae. The membranes can usually be removed during surgery and no further treatment is required.

In spina bifida meningocele, the nervous system is undamaged. However, a person with meningocoele may develop other problems, including bladder and bowel problems.

Spina bifida is a term that is used to describe a series of birth defects that affect the development of the spine and central nervous system. The central nervous system is made up of the brain, nerves and spinal cord. The spinal cord runs from the brain to the rest of the body and consists of nerve cells and bundles of nerves that connect all parts of the body to the brain.

The neural tube

During the first month of life, an embryo (developing baby) grows a primitive tissue structure called the neural tube. As the embryo develops, the neural tube begins to change into a more complicated structure of bones, tissue and nerves that will eventually form the spine and nervous system.

However, in cases of spina bifida, something goes wrong with the development of the neural tube and the spinal column (the ridge of bone that surrounds and protects the nerves) does not fully close. Spina bifida is a Latin term that means split spine.

Types of spina bifida

There are different types of spina bifida, including:

• spina bifida occulta
• spina bifida meningocele
• myelomeningocele

This article focuses on myelomeningocele and this is the type of spina bifida that will be referred to whenever the term spina bifida is used. See the box to the left for information about spina bifida occulta and spina bifida meningocele

Myelomeningocele

Myelomeningocele is the most serious type of spina bifida. It is estimated that it affects one baby in every 1,000 that are born in Britain.

In myelomeningocele, the spinal column remains open along several vertebrae (the disc-shaped bones that make up the spine). The membranes and spinal cord push out to create a sac in the baby’s back. Sometimes the sac is covered with membranes called meninges, although it often remains open, leaving the nervous system vulnerable to infections that may be fatal.

In most cases of myelomeningocele, surgery can be carried out to close the defect. However, extensive damage to the nervous system will usually have already taken place. Damage can result in a range of symptoms including:

• partial or total paralysis of the lower limbs
• bowel incontinence and urinary incontinence
• loss of skin sensation

Most babies with myelomeningocele will also develop hydrocephalus, which is a condition where there is excess cerebrospinal fluid (CSF). CSF is the fluid that surrounds the brain.

The build-up of CSF is caused by problems with the development of the neural tube. Hydrocephalus needs to be treated with surgery because the extra pressure that the fluid places on the brain can cause brain damage.

See the Health A-Z topic about Hydrocephalus for more information about the condition.

Outlook

Over recent years, advancements in the treatment of spina bifida have resulted in a more positive outlook for the condition.

For example, before the 1960s, most children with spina bifida would die during their first year of life. However, today it is likely that children will survive into adulthood. Spina bifida can be a challenging condition to live with, but many adults with the condition are able to lead independent and fulfilling lives.

See Spina bifida - treatment for information about the range of different techniques that can be used to treat the condition.

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