Spina Bifida Occulta Found on X-Ray: Is It Serious?
No, spina bifida occulta found on an X-ray is usually not serious because it often causes no symptoms or need for treatment. However, in rare cases, a tethered spinal cord can affect nerve function. When this occurs, you may notice leg weakness, numbness, or sudden bladder or bowel symptoms, which require medical evaluation.
At Total Orthopedics & Sports Medicine, our spine specialists can assess whether the spinal gap affects nearby nerves or the spinal cord. If your symptoms suggest a spinal cord issue, we may perform a detailed exam and order advanced imaging to identify the source of your symptoms. Once we understand the cause, we recommend monitoring or treatment based on your symptoms and neurological findings. Call 855-321-6784 to schedule an evaluation.
Should You Worry About Spina Bifida Occulta?
No, you usually do not need to worry about this mild spinal condition because most people have no symptoms. It occurs when a small gap forms between one or more backbones, while the spinal cord and nerves develop normally. The term “occulta” means hidden because skin covers the area without an open fluid sac.
In fact, research published in Clinical Orthopaedics and Related Research reports that spina bifida occulta affects about 10% to 20% of the U.S. population. The condition causes no symptoms in almost all cases. For this reason, many people only discover it when an X-ray shows a difference in one or more spinal bones.
Another study published in Spine examined 3,100 spinal specimens. Researchers found SBO in 12.4% of the specimens. Among those with SBO, 53% had Grade I, 37% had Grade II, and 10% had Grade III. Moreover, CDC data show that spina bifida birth prevalence is highest among Hispanic women in the U.S.
However, you should seek medical attention if you notice any of the following warning signs:
- Leg pain: Pain travels down one or both legs.
- Muscle weakness: Your legs or feet become weak or numb.
- Walking problems: You have trouble with walking or balance.
- Bladder or bowel changes: You develop new bowel or bladder symptoms.
- Bone changes: You develop foot deformities or a curved spine.
What Does Spina Bifida Occulta Look Like on X-Ray?
An X-ray usually shows a small gap or cleft in the back part of one or more vertebrae (spinal bones). This gap occurs when the bony arch does not form properly or is not completely closed. Doctors most often notice this finding in the lower spine, especially near L5 or S1.
In the image, the defect can appear as a dark split in the middle of the bony arch. However, the skin still covers the area, unlike open spina bifida, and the spinal cord usually stays protected within the spinal canal. Since most people have no symptoms, doctors often find the gap during an X-ray for another concern, such as lower back pain.
Which Factors Increase the Risk of Spina Bifida?
Low folic acid levels and a family history of neural tube defects can raise the risk during early pregnancy. Other factors linked to a higher risk of spina bifida are diabetes, obesity, and certain antiseizure medicines, such as valproic acid. Some environmental risk factors, such as high body temperature from fever or hot tubs early in pregnancy, may also affect early spinal development.
Here is how these risk factors may affect early spinal development and increase the risk of spina bifida:
1. Low Folate Levels
Folate deficiency is a common risk factor for neural tube defects. Your body needs folate, or vitamin B9, during early fetal development. Without enough folic acid, the neural tube may not close completely as the baby’s spine develops. For this reason, doctors recommend folic acid supplements before conception and during early pregnancy.
2. Family History
Genetics can increase the chance of a neural tube defect in some families. However, most babies with spina bifida do not come from families with multiple affected relatives. According to research published in the Journal of Pediatric Rehabilitation Medicine, about 95% of families studied had only one person with spina bifida or anencephaly. Still, the reported risk among siblings of an affected person ranges from 3% to 8%. Moreover, babies assigned female at birth may be more affected by spina bifida, although findings vary across studies.
3. Certain Antiseizure Medicines
Some medicines used to treat epilepsy can affect fetal development when taken during pregnancy. For example, valproic acid has a recognized association with neural tube defects, especially during early pregnancy. The risk may relate partly to changes in folate metabolism (how the body processes folate).
Important Note: Anyone taking antiseizure medicines should discuss pregnancy plans with their doctor before changing or stopping treatment.
4. Diabetes
Diabetes before pregnancy can raise the risk of neural tube defects, especially when blood sugar levels are poorly controlled. High glucose levels during early fetal development can interfere with normal tissue formation. In contrast, good diabetes control before conception and during pregnancy can reduce pregnancy-related risks. Your medical team can guide blood sugar targets and medication use during this period.
5. Pre-Pregnancy Obesity
A systematic review and meta-analysis in PubMed found a higher risk with maternal obesity. The odds of spina bifida were 2.24 times higher compared with the recommended maternal BMI. Several metabolic and nutritional factors may contribute to this association. However, researchers have not identified a single definitive cause. For this reason, preconception care is essential to address weight, nutrition, and other health factors before pregnancy.
6. High Body Temperature
High body temperature is one of the environmental factors associated with an increased risk of neural tube defects. A high fever or prolonged exposure to hot tubs and saunas can raise core body temperature during early pregnancy. This period is important because the neural tube later develops into the brain and spinal cord. Prompt treatment of fever and limited exposure to excessive heat can reduce this potential risk.
Does Spina Bifida Occulta Cause Back Pain?
Spina bifida occulta usually does not cause routine mechanical back pain. However, pain can develop if an extensive defect occurs with an underlying spinal cord or nerve problem. In rare cases, a tethered spinal cord can attach to nearby tissue and place tension on the nerves as a child grows.
This tension can irritate nearby nerves and cause back pain along with other symptoms of spina bifida, such as leg weakness or numbness. One 2025 RJMNSR review reports that about 1 in 1,000 people diagnosed with spina bifida occulta experience symptoms. Therefore, new pain with neurological changes requires evaluation for possible nerve damage or an associated spinal cord problem.
Can a Hidden Spinal Defect Get Worse With Age?
No, the small gap in the spine does not usually progress or worsen with age. This bone difference develops before birth and does not continue to grow later in life. However, symptoms can appear later in a small number of people due to changes around the spinal cord.
For example, a growth spurt during childhood or adolescence can place tension on a tethered spinal cord (a spinal cord attached to nearby tissue). This tension can affect nerve function and cause changes in bladder and bowel function. In other cases, an imaging test after a back injury or due to age-related spinal changes may reveal a hidden defect.
When Do You Need an MRI After the X-Ray Finding?
You may need an MRI if spina bifida occulta occurs with neurological symptoms or progressive spinal changes. Unlike an X-ray, an MRI can show the spinal cord and nerves and detect problems such as a tethered cord. These findings can help your spine specialist determine if the condition needs further evaluation or treatment.
A doctor may also recommend an MRI if you notice physical changes that suggest an underlying spinal cord problem, such as:
- Visible skin markers: A deep dimple, hairy patch, unusual birthmark, or fatty lump over the lower spine.
- Changes during growth: New foot deformities or walking problems that develop as a child grows.
Could Spina Bifida Occulta Mean You Have a Tethered Cord?
No, spina bifida occulta does not automatically mean you have a tethered cord. However, the two conditions can occur together in some people. Most people have only a small gap in the spinal bones, while the spinal cord develops normally within the spinal canal.
In rare cases, extra tissue can attach the cord to nearby structures and restrict its movement. This attachment can place tension on the spinal cord and affect nearby nerves. As a child grows, increased tension may also affect muscle function and cause new neurological symptoms. Although these conditions can occur together, here are the key differences:
| Feature | Spina Bifida Occulta | Tethered Cord |
|---|---|---|
| Main problem | Small gap in the spinal bones | The spinal cord attaches to nearby tissue |
| Spinal cord | Usually develops normally | Cannot move freely in the spinal canal |
| Symptoms | Usually none | May cause pain, weakness, or numbness |
| Skin signs | A dimple, a hairy patch, or a birthmark may occur | Similar skin markers may suggest tethering |
| During growth | Usually does not change | Cord tension may increase as a child grows |
| MRI | Often unnecessary when isolated | Used to assess the spinal cord and tethering |
Is a Hidden Spinal Defect the Same as Spondylolysis?
No, spina bifida occulta and spondylolysis are not the same condition. Spina bifida occulta is a developmental defect in which the back part of a vertebra does not fully close. In contrast, spondylolysis is a defect or stress fracture in the pars interarticularis, a small part of the vertebra.
Although they are distinct conditions, they can sometimes occur together. For example, a 2020 study published in Case Reports in Orthopedics described a 37-year-old man with both conditions at the L1 vertebra. Imaging also showed severe spinal canal narrowing at L1-L2. This narrowing affected the nerves, contributing to leg weakness and difficulty walking.
Open vs Closed Spina Bifida: What Is the Difference?
Open spina bifida occurs when spinal tissue lacks normal skin coverage, which increases the risk of neurological disorders. In contrast, the closed form keeps the spinal defect beneath intact skin and usually causes fewer or no symptoms. These types of spina bifida also differ in their clinical manifestations, nerve effects, and treatment needs based on the following features:
| Feature | Open Spina Bifida | Isolated Spina Bifida Occulta |
|---|---|---|
| Appearance | Exposed tissue or a sac may appear | May show a dimple, birthmark, or patch of hair |
| Nerve effects | Higher risk of neurological problems | Nerves often fully develop normally |
| Severity | Usually more serious | Usually milder |
| Treatment | May require fetal or postnatal surgical repair | Often needs no treatment |
| Later concerns | Neurological problems may continue | A rare tethered cord may cause symptoms later |
What are the treatment options for Spina Bifida Occulta?
Most people with spina bifida occulta need no treatment. However, guided rehabilitation or medications may address symptoms if they develop. Occupational therapy, braces, or mobility aids can provide further support when weakness affects movement. These options target specific symptoms rather than the small spinal gap itself.
In rare cases, spina bifida occulta is treated with surgery when a tethered spinal cord causes progressive neurological problems. Surgery can release tension on the spinal cord and protect nerve function from further decline. The need for this procedure depends on your symptoms, neurological exam, and MRI findings.
What Is the Life Expectancy With Spina Bifida?
Up to 90% of people born with spina bifida survive into adulthood, with many living beyond age 30. However, life expectancy depends on the type of spinal defect and the severity of associated neurological problems. It can also vary based on complications, access to medical care, and long-term management of the condition.
Moreover, the Centers for Disease Control and Prevention (CDC) reports that first-year mortality ranged from 0% to 20% across the studies it reviewed. However, most reports showed much lower rates, ranging from 2% to 6%. Another international study published in Paediatric and Perinatal Epidemiology examined spina bifida outcomes across 18 countries.
The researchers found that 90% to 96% survived to age five in Europe. In North America, five-year survival ranged from 86% to 96%. The National Institute of Neurological Disorders and Stroke (NINDS) also reports that most people with spina bifida live long lives.
Important Note: These survival rates mainly apply to open spina bifida. Spina bifida occulta usually does not shorten your lifespan.
Get a Second Opinion From Our Spine Specialists If Spina Bifida Appears on Your X-Ray!
You may feel concerned when an X-ray unexpectedly shows a hidden gap in your spine. Even without symptoms, you may question if the finding affects your spinal cord or nearby nerves. If you also have back pain, weakness, numbness, or bladder and bowel changes, a spine evaluation can identify the cause of your symptoms.
At Total Orthopedics & Sports Medicine, our spine specialists provide a second opinion on your X-ray findings. We compare your imaging with your symptoms and neurological exam to check for a tethered cord or any underlying spinal problem. After a complete review, we explain if the finding needs monitoring, further imaging, or treatment to protect your nerve function. Call 855-321-6784 or visit our clinics in Syosset, Massapequa, East Meadow, or Deer Park to consult our spine specialists.
FAQs
Does Spina Bifida Occulta Qualify as a Disability?
No, spina bifida occulta does not usually qualify as a disability because most people have no symptoms or functional limitations. However, the diagnosis alone does not determine eligibility for disability benefits. Qualification depends on the severity of your symptoms and their effect on mobility, daily activities, and ability to work.
Why Does Spina Bifida Occulta Cause a Dimple on the Back?
A back dimple can develop when the spinal bones do not close completely during fetal development. This defect may create a fibrous connection between the skin and deeper spinal structures. As a result, a small dimple may appear on the skin over the affected area.
How is Spina Bifida Occulta Diagnosed Before and After Birth?
Spina bifida occulta is usually diagnosed after birth, often by chance on an X-ray. Many babies born with this mild form have no visible signs. Unlike open spina bifida, it is rarely found during prenatal screening. If neurological symptoms develop later, your doctor may order an MRI.
Do Children With Spina Bifida Have Learning Problems?
Yes, some children can develop learning disabilities, especially when hydrocephalus (fluid buildup in the brain) is present. In comparison, most children with isolated spina bifida occulta do not develop learning problems. This mild spinal defect usually does not affect brain development or learning ability.
Can I Play Sports With a Hidden Spinal Defect?
Yes, you can usually play sports safely when spina bifida occulta causes no pain, weakness, or nerve symptoms. Activities such as swimming, walking, and cycling can strengthen your core and support your spine. However, stop the activity and seek medical evaluation if you develop sharp back pain, leg numbness, or unusual weakness.
