Question
Hello,

My son is 13 and was just recently diagnosed with spina bifida occulta. The Xray was taken after we noticed a curving of his spine. The curving is not significant (our doctor said it's not scoliosis yet but we'll be monitoring the curving in 6 month intervals).

My question is - can my son play contact sports (soccer) or he should stop because of any risks associated with the spina bifida occulta.

Thank you in advance.

Respectfully yours,
Ana  

Answer
Hello, welcome to allexperts.com!

To me your question has two parts... and I may surprise you.

Your son is 13.  Has he been active before? played sports before? competed before? Has he ever complained of any back pain? have any symptoms: pain, pain into the butt, pain into the legs, numbness, tingling?  ever any complaints relating to the back (particularly the low back)?

You noticed a 'curving' and went for an Xray and discovered the Spina Bifida Occulta (occulta, occult = hidden).

 Luckily you have the Occulta form, the mildest form, the 'hidden' form of spina bifida.  I myself have spina bifida occulta.  It has never hindered me in any way. For many older Americans - Spina Bifida conjures up terrible pictures of severe deformity, disability even death.

Spina Bifida = a bifid spine, bifid spinous process, split spine.  When we feel down our backs, when we pet a cat or dog, when we pet midline along the spine, the bumps we feel are the 'spinous processes' of the spine.  The spinous process is the most posterior portion of the spine.  The spinous process is similar to the point of a triangle, the vertebral body is the base, a right and left 'arm' come out of the base, encircle the spinal cord, and meet at the back of the back, forming the spinous process.  If this spinous process is closed, all is 100% fine and normal, and that is the part of the spine we feel when we pet.

IF that spinous process does not meet and fuse, if the point of the triangle is open, we have an opening, a cleft, a split, a bifid spinous process; hence, spina bifida.

As with most things spina bifida can be mild, moderate or severe.
Spina Bifida Occulta is the mildest form of spina bifida.  Actually from there we move 'up' to Spina bifida manifesta- which  includes two types of spina bifida, meningocele and myelomeningocele (manifesta= manifest, visible, observable).

Spina Bifida Meningocele means that there is some kind of involvement/ exposure of the meninges.  Meninges cover the brain and spinal cord.  This, of course is much more significant than occulta and certainly needs medical management.

Spina Bifida Myelomeningocele is even more severe, and again requires medical management.  I have not seen either of the Spina Bifida Manifesta types in my office.

I have Spina Bifida Occulta.  It has never bothered me.  All of the studies I have seen indicates Occulta is not clinically significant.

You have Xrays, and your Doctor of Chiropractic can evaluate those Xrays, look at the spina bifida and give you more exact recommendation.  But I would not expect Occulta to be a problem.  Let him run, jump, be active play soccer.

now...

Spinal curvature, but NOT a scoliosis ?

I do not understand this.  Spinal curvature in the lateral plane IS the definition of scoliosis.

You noticed a curvature?

You noticed a curvature, and then had Xrays?  Xrays show a 'curvature', but it is NOT a scoliosis ?  Bring those Xrays to another Chiropractor.

Obviously, as a Doctor of Chiropractic, I treat spines all day.  To me, the spinal 'curvature' is more clinically significant than the spina bifida occulta.

Your son is 13. Still growing. I treat spines all day and do not like to predict which spine will continue to curve (worsen), or start to straighten (get better).

The spine is alive.  Bones are alive.  Bones change shape.  Bones are dynamic, even if they change slowly.  When growing, bones can change shape even faster- for better or worse.  

When I see a spina bifida, even occulta, I make sure I have pictures of the entire spine (Xrays).  Once there is one peculiarity, one abnormality, there may be others.  Looking at the whole spine, I now assume we only see the spina bifida occulta as the only bony deformity; with all of the rest of the bones proper size, shape.

Now I see a curvature.  Is the pelvis level (the foundation, the basement of the spine)?  ANY curvature I see on the AP Xray film, any curvature in the latereal plane is a scoliosis by definition.

As a chiropractor I will measure the degree of curvature.  I will log that degree.  I will examine the patient standing, sitting, lying prone and supine.  I will look for leg length discrepancy, I will look for pelvic misalignment. If there is a curvature, with no boney cause of the curvature, I will look for the joint or joints in trouble, causing that curvature.  I will look for a chiropractic subluxation.

A chiropractor will monitor, evaluate and treat such a case (depending upon severity of the curve) once a week, twice a month, once a month.  I will adjust and monitor in office. Exercises will be given depending upon the curve.  A nice, simple exercise, is simply 'hanging around the house'. By 'hanging'= get a chin-up bar, a chinning bar in the house. Have the boy hang twice a day, once in the AM, once in the afternoon.  Get two minutes of hang time, twice a day.  No one hangs two minutes in two minutes time.  Maybe it will take four tries at 30 seconds a piece to add up to two minutes, but hang until two minutes is reached.  Exercise as instructed by the treating DC. See the DC for a treatment regimen. Monitor each visit. Xray after six months. Look for changes. The spine could change, it is dynamic.

I would not just 'wait and see' for six months.  It may get worse, it may get better.  Treat the curve that exists now, it should get better.  Why wait for it to get worse to begin treatment?  It may get better on its own. it may not. Treat the current problem currently.

Personally, this chiropractor would be more concerned with the curvature than the occulta.

Thanks, Good Luck.  As always, visit your own Doctor of Chiropractic for specific recommendations for your specific case.  This discussion is for general information only.

Vic Dolan, DC
http://www.DocDolan.net