Neural Tube Defects in Adulthood

Neural tube defects (NTDs), most commonly spina bifida and tethered cord syndrome, are congenital malformations of the developing neural tube. Many adults present with sequelae of childhood-diagnosed disease, while others present in adulthood with new symptoms from previously occult or compensated lesions.

Adult manifestations include progressive lower limb weakness and spasticity, neurogenic bladder and bowel dysfunction, lumbosacral pain, scoliosis and orthopedic deformities. Tethered cord syndrome can occur de novo or recur after pediatric repair due to scar tethering.

Management requires multidisciplinary care including neurosurgery for symptomatic detethering, urology for bladder management, orthopedics for spinal and lower limb issues and rehabilitation. Prevention via adequate periconceptional folic acid supplementation and prenatal screening remains the cornerstone of public health strategy.