Describe the clinical features of spina bifida occulta

In spina bifida occulta the underlying spinal and/or neural defect is covered by intact skin and thus may not be grossly evident on examination. External signs may include a lumbosacral hair tuft (faun's tail), skin-covered lipoma, cutaneous hemangioma, or a lumbosacral skin dimple. If the defect is limited to failure of fusion of the vertebral arch, the finding has little clinical significance. However, more complex types are associated with neurologic, urologic, and/or orthopaedic abnormalities. The majority of more complex cases will require surgical intervention to prevent progression of neurologic deficits.

Associated neurologic findings may include lower extremity atrophy, weakness, radicular pain, or numbness. Urologic signs may include an abnormal voiding pattern in an infant, new incontinence after toilet training, or a urinary tract infection in a child of any age. Orthopaedic findings may include cavovarus foot deformities, clawtoes, leg-length discrepancy, and scoliosis. Diagnosis is often delayed until adolescence or adulthood, due to absent initial neurologic or urologic findings. Early identification is paramount because prophylactic surgery is usually indicated to preserve neurologic function.

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