Spinal hemorrhages are associated with early neonatal motor function loss in human spina bifida aperta

D. A. Sival, R. J. Verbeek, O. F. Brouwer, K. M. Sollie, A. F. Bos, W. F.A. den Dunnen

Research output: Contribution to journalArticleAcademicpeer-review

24 Citations (Scopus)


Background: In spina bifida aperta (SBA), leg movements caudal to the meningomyelocele are present in utero, but they disappear shortly after birth. It is unclear whether leg movements disappear by impact of the neuro-developmental malformation or by superimposed traumatic damage. If superimposed traumatic damage is involved, targeted fetal intervention could improve motor outcome. Aim: To characterize neuromuscular pathology in association with perinatal motor function loss in SBA. Patients/methods: In fetal SBA (n = 8; 16-40 weeks GA), the median time interval between ultrasound registrations of fetal motor behavior and post-mortem histology was 1 week. Histology was assessed cranial, at and caudal to the meningomyelocele and compared with findings in fetal controls (n = 4). Results: Despite fetal movements caudal to the meningomyelocele (5/6), histology indicated muscle fiber alterations (6/6) that concurred with neuro-developmental and traumatic spinal defects [Neuro-developmental defects: spinal ependymal denudation (3/8), reduced amount of (caspase3-negative) lower motor neurons (LMNs; 8/8), aberrant spinal vascularization (8/8). Traumatic defects: gliosis (7/8), acute/fresh spinal hemorrhages near LMNs (8/8)]. Conclusion: In all delivered SBA patients, recent spinal hemorrhages were superimposed upon pre-existing defects. If early therapeutic strategies can prevent these superimposed secondary spinal hemorrhages, motor outcome may improve.

Original languageEnglish
Pages (from-to)423-431
Number of pages9
JournalEarly Human Development
Issue number7
Publication statusPublished - Jul 2008


  • Ependymal denudation
  • Fetal movement
  • Histology
  • Motor neuron
  • Spina bifida
  • Spinal hemorrhage

Cite this