Conventional radiographs of the lumbar spine may add additional information concerning the segmentation and dorsal bony anatomy of the spine, but cannot be used to screen patients for surgically significant

pathology. Etiologic Risk Factors Although no clear etiology is known to result in either the open or closed forms of spinal dysraphism, some regional adverse factors have been reported, primarily MLN0128 in vitro involving the mother at conception and early pregnancy. Inhibitors,research,lifescience,medical Approximately 50% of cases are related to nutritional deficiency66; the remaining cases, which are inherited, are multifactorial. Some of the other causes are chromosomal abnormalities, single-gene abnormalities, Inhibitors,research,lifescience,medical environmental factors,67 or are unknown. The ingestion of cytochalasin, a metabolite of the fungus Phytophthora infestans (found in blighted potatoes), folic

acid or zinc deficiency, high nitrates (eg, nitrate-cured meats, bore and ground water), and vitamin A deficiency or excess have all been shown to be possible maternal nutritional causal elements.68,69 An altered carbohydrate Inhibitors,research,lifescience,medical metabolism (eg, diabetes mellitus, hyperinsulinemia, or insulin-albumin antagonism) has been reported to be present in mothers of children with spinal dysraphism, particularly those with sacral agenesis. Mothers with diabetes are more prone to give birth to children with spinal dysraphism.70 Inhibitors,research,lifescience,medical One of the most important nutritional factors related to the advent of spinal dysraphism is the lack of folic acid. The use of supplementary folic acid may reduce neural tube defects by up to 72%.68 Although no association with socioeconomic status has been well

documented, significant evidence exists to support the importance of genetic factors in the development of spinal dysraphism.71 There is a 3-fold higher incidence in consanguineous marriages, as well as a higher incidence in monozygotic Inhibitors,research,lifescience,medical twins. The mother of an affected child is 50 times more likely to have a second affected child (ie, a 5% chance) and is 100 times more likely (ie, a 10% chance) if she has had 2 previously affected children.2 Recommendations before During Pregnancy During pregnancy, mothers are advised to avoid hyperthermia (eg, fevers, hot saunas or baths), as well as several medications (eg, valproic acid, clomiphene, and folic acid antagonists, such as aminopterin). The dietary folic acid supplement is recommended to be 0.4 mg daily for all women of childbearing age and is 10 times that amount (4.0 mg daily) if there has been a previous pregnancy with an affected fetus.72 Associated Congenital Anomalies Table 5 depicts the most common urologic anomalies present in patients with spinal dysraphism.