Spina Bifida Occulta (SBO) is a common congenital anomaly of the spine that often goes undetected throughout a person’s life. This condition involves a small gap or malformation in the vertebrae, developing early during fetal growth. Whether SBO is considered a disability is not straightforward and depends entirely on the presence and severity of symptoms. Functional limitations, not the diagnosis itself, determine how legal and governmental bodies assess the condition.
Understanding Spina Bifida Occulta
Spina Bifida Occulta (SBO), which translates to “hidden split spine,” is the mildest and most frequent form of spina bifida. It is characterized by the incomplete closure of the bony arch on the back of one or more vertebrae, typically in the lower back. This structural defect differs significantly from severe forms, such as myelomeningocele, where the spinal cord and nerves protrude through an opening. The condition is considered “hidden” because the bony opening is covered by skin, and the spinal cord remains in its proper position. SBO affects an estimated 10% to 20% of the general population, and in the vast majority of cases, it is asymptomatic and discovered only incidentally during unrelated imaging.
The Threshold for Symptomatic Presentation
While SBO is generally benign, a small percentage of individuals (approximately 1 in 1,000) may eventually develop symptoms that create functional limitations due to neurological involvement. The primary complication leading to symptoms is Tethered Cord Syndrome (TCS). TCS occurs when the spinal cord becomes abnormally attached to surrounding tissues or bone near the original bony defect. This attachment prevents the spinal cord from moving freely as the person grows, causing chronic tension and stretching that damages neural tissue.
Symptoms of Tethered Cord Syndrome
The symptoms arising from a tethered cord relate directly to the affected nerves. These can include chronic back pain, progressive weakness in the legs, and noticeable changes in gait or foot shape. The condition can also affect nerves controlling the bladder and bowel, leading to dysfunction such as incontinence or difficulty with control. These functional impairments, not the anatomical defect itself, form the threshold for seeking medical intervention and potential disability status.
Disability Classification and Functional Limitation
Spina Bifida Occulta, in isolation, is not classified as a disability because the diagnosis alone does not indicate an impairment of major life activities. Disability determination for governmental support programs focuses on documented, severe, and long-lasting functional limitations, not the medical diagnosis code. The Social Security Administration (SSA) evaluates claims based on the inability to work or a child’s inability to function comparably to peers.
If SBO leads to complications like Tethered Cord Syndrome, the resulting motor and neurological deficits may meet the criteria for disability benefits (SSI or SSDI). The application must prove the severity of the functional limitation, such as major motor dysfunction, significant neurogenic bladder or bowel issues, or severe skeletal disorders like scoliosis. The key factor is establishing that the impairment severely restricts daily activities and requires ongoing medical management.
Similarly, under the Americans with Disabilities Act (ADA), an individual must demonstrate that the condition, through its complications, substantially limits one or more major life activities, such as walking, self-care, or working. The pathway to disability status for SBO is through its impact on the nervous system and resulting functional decline, not the initial anatomical variation.
Managing Symptomatic Spina Bifida Occulta
When SBO becomes symptomatic, management focuses on relieving pressure on the spinal cord and mitigating functional deficits. For individuals experiencing mild symptoms, non-surgical approaches are the first line of treatment, including physical therapy to improve strength and mobility, and pain management techniques.
If neurological symptoms are progressive, severe, or involve significant bladder or bowel dysfunction, surgical intervention is typically required. The most common procedure is detethering surgery, which carefully releases the spinal cord from surrounding tissue to restore free movement. This aims to prevent further nerve damage and potentially reverse existing neurological symptoms. Following surgery, rehabilitation involving physical and occupational therapy is necessary to regain lost function. Medications may also be prescribed to manage chronic pain or restore control over neurogenic bladder and bowel issues.