💥Associated with cord abnormalities (spinal dysraphism)
💥70% of those with cord abnormalities have dimpling or a hairy naevus at the base of the spine.
💥30% of patients with spinal dysraphism have neurological signs.
💥If such a patient comes for surgery, an MRI scan should be done to rule out a tethered cord.
💥Once this is excluded, it may be appropriate to proceed with regional analgesia at a site above the lesion.
💥The patient should be explained about the higher incidence of dural puncture because of abnormal ligamental structure.
💥Another point is, there may be incomplete spread of anaesthetic to sites below the lesion and consequently a suboptimal block may occur.
💥The epidural space volume is usually reduced and so, the epidural should be established with small aliquots of local anaesthetic to prevent a high block.
💥Spina bifida is also associated with a difficult intubation.
💥Spina bifida is a risk factor for latex allergy
Ref: Ali L, Stocks GM. Spina bifida, tethered cord and regional anaesthesia. Anaesthesia. 2005; 60(11): 1149–1150. Griffiths S, Durbridge JA. Anaesthetic implications of neurological disease in pregnancy. Contin Educ Anaesth Crit Care Pain. 2011; 11(5): 157–161. D’Astous J,Drouin MA, Rhine E 1992 Intraoperative anaphylaxis secondary to allergy to latex in children who have spina bifida. Report of two cases. Journal of Bone & Joint Surgery 74: 1084–6.
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