Spina bifida is a complicated birth defect, which has occurred in human beings for thousands of years. In the United States, spina bifida is the second most common birth defect and affects about one out of every one thousand pregnancies. In some babies, for reasons that appear to be a combination of environmental and genetic factors, normal development is interrupted anywhere from the brain to the end of the spinal cord and the birth defect called spina bifida results. This problem occurs very early in pregnancy, probably in the third or fourth week following fertilization. It is possible that only the bones of the spinal column will be incompletely developed and that the nerves beneath will be normal. This condition, called spina bifida occulta, does not cause neurological problems such as paralysis or weakness and is not medically significant. When the spinal cord itself is not fully formed however, the nerves do not develop as they should and the baby will have myelomeningocele, the most severe form of spina bifida (Sandler, 1997). It is this type of spina bifida that will be covered.

Myelomeningocele is a complex malformation of the spinal cord, nerve roots, meninges, vertebral bodies, and skin (Sandler, 1997). This neural tube defect is a common congenital anomaly and typically is referred to as spina bifida. This condition results from failure of the neural tube to close in the developing fetus. Medical, surgical, and rehabilitation issues arise in the patient with myelomeningocele from birth through adulthood (Spotlight on Spina Bifida).

Myelomeningocele often occurs with multiple system congenital anomalies. Commonly associated anomalies are facial clefts, heart malformations, reproductive and urinary tract irregularities (Lutkenhoff, 1999). Urinary tract abnormalities, such as solitary kidney or malformed ureters, may contribute to increased morbidity in the presence of neurogenic bladder dysfunction.