The label of'spina bifida' or 'spina bifida occulta' is commonly applied to vertebral clefts observed on medical images, particularly those located in the lumbosacral regions. Related to this, authorities quote relatively high worldwide incidence figures for spina bifida occulta ranging from 1:10 to 1:4. However, recent work on human skeletal material has shown that many vertebral clefts may be the result not of neural tube field disruption, but of disturbance in the normal development of the paraxial mesoderm field. Defects arising from these two developmental fields can produce lesions that look the same on medical images, but when diagnosed from dry bone, may be differentiated appropriately. As the two developmental fields produce a different range and type of associated health issues, these findings may call into question the blanket diagnosis of'spina bifida occulta' often used on image reports. Whilst it is usually impossible to distinguish between the two types of cleft on some images, it may be advisable to consider the alternative label of 'vertebral arch nonfusion' as a more accommodating description, rather than the diagnosis of spina bifida occulta. While not wishing or intending to take away the responsibilities of the reporter in interpreting images, this may be a more accurate method of identifying vertebral clefts. It allows for the possibility that clefts may originate from different fields and may indicate to clinicians the possible presence of other hidden anomalies that may require investigation. This issue may also be of considerable importance when observing the foetal spine on ultrasound investigations. Early warning of ossification anomalies may allow for further investigation following up possible paraxial mesoderm defects for associated anomalies such as some genito-urinary, gastrointestinal and oral cleft conditions.
展开▼
