Incidence of Spina bifida occulta is 10%–25% of the population.

Associated with cord abnormalities (spinal dysraphism)

70% of those with cord abnormalities have dimpling or a hairy naevus at the base of the spine.

30% of patients with spinal dysraphism have neurological signs.

If such a patient comes for surgery, an MRI scan should be done to rule out a tethered cord.

Once this is excluded, it may be appropriate to proceed with regional analgesia at a site above the lesion.

The patient should be explained about the higher incidence of dural puncture because of abnormal ligamental structure.

Another point is, there may be incomplete spread of anaesthetic to sites below the lesion and consequently a suboptimal block may occur.

The epidural space volume is usually reduced and so, the epidural should be established with small aliquots of local anaesthetic to prevent a high block.

Spina bifida is also associated with a difficult intubation.

Spina bifida is a risk factor for latex allergy

Ref: Ali L, Stocks GM. Spina bifida, tethered cord and regional anaesthesia. Anaesthesia. 2005; 60(11): 1149–1150. Griffiths S, Durbridge JA. Anaesthetic implications of neurological disease in pregnancy. Contin Educ Anaesth Crit Care Pain. 2011; 11(5): 157–161. D’Astous J,Drouin MA, Rhine E 1992 Intraoperative anaphylaxis secondary to allergy to latex in children who have spina bifida. Report of two cases. Journal of Bone & Joint Surgery 74: 1084–6.