We are the combination of four hospitals: the General Hospital, the Children’s Hospital, the Women’s Hospital and the Traumatology, Rehabilitation and Burns Hospital. We are part of the Vall d’Hebron Barcelona Hospital Campus: a world-leading health park where healthcare plays a crucial role.
Patients are the centre and the core of our system. We are professionals committed to quality care and our organizational structure breaks down the traditional boundaries between departments and professional groups, with an exclusive model of knowledge areas.
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The commitment of Vall d'Hebron University Hospital to innovation allows us to be at the forefront of medicine, providing first class care adapted to the changing needs of each patient.
The term neural tube defects (NTDs) or spina bifida refers to a diverse group of congenital malformations of the central nervous system that primarily affect the spinal cord and vertebral column. In the most severe cases, such as myelomeningocele and meningocele, there is a failure of the vertebral column to close, allowing the spinal cord to protrude externally (open defects). Milder forms, such as lipomas or lipomyelomeningocele, present as a soft mass covered by skin, a hairy lumbar patch, or may go unnoticed (closed defects). The most severe defects can be associated with other brain malformations, such as Chiari II malformation.
The cause of neural tube defects (NTDs) is unknown, but current evidence suggests that genetic predisposition combines with external factors. Some of these factors are recognized (such as valproic acid or methotrexate), but in most cases, they are related to a deficiency or interference in folic acid metabolism.
Administration of folic acid to women before conception has reduced the incidence of the malformation.
Prenatal diagnosis is usually performed via ultrasound. Since 2011, our hospital has applied an ultrasound-based technique, developed by rehabilitation doctors and obstetricians, that allows prenatal determination of the type and motor level of the fetus with spina bifida. This enables an individualized and reliable prognosis of the child’s motor and functional abilities.
Patients with myelomeningocele:
Patients with lipomas or lipomyelomeningocele:
The treatment of choice for open defects is prenatal surgical closure between 24–26 weeks of gestation, aiming to minimize sequelae from the malformation.
From birth, a child with spina bifida must be monitored in a specialized unit that guarantees their lifelong care and therapeutic needs. The multidisciplinary team should include obstetricians, pediatricians, neurosurgeons, urologists, orthopedic surgeons, pediatric surgeons, rehabilitation doctors, physiotherapists, occupational therapists, nurses, and orthotic technicians.
Treatment must be individualized, as different types of neural tube defects lead to different sequelae.
Basic objectives of NTD treatment:
The Spina Bifida Unit at our hospital has existed since the 1970s. It is the only unit in the area that can provide continuous care from birth throughout life, with the same team of professionals.
The rehabilitation doctor coordinates the unit, integrating the various therapeutic proposals to ensure they are realistic and achievable. This approach prevents unfeasible recommendations that could cause disappointment for families and suffering for the patient.
Orthopaedic Surgery and Traumatology, Traumatology, Rehabilitation and Burns Hospital
Nursing Management, General Hospital
Paediatric Orthopaedic Surgery, Children's Hospital and Woman's Hospital
Internal Medicine, General Hospital
The lower part of the back has to carry the weight of the upper body and enables the torso to move, bend and stretch. Most lower back pain is the result of injury to muscles, ligaments, joints or spinal discs.
Lower back pain is limited to the lumbar region of the back, and may be associated with radiating pains and/or numbness in the legs.
Most acute lower back pain originates in muscles or ligaments, and is self-limiting, although it can still be incapacitating. It is usually the result of injury to muscles, ligaments, joints or spinal discs.
Chronic lower back pain is defined as pain persisting for more than 3 months, and is one of the most frequent and costly musculoskeletal problems of modern society. It is estimated that up to 80% of the adult population will suffer from lower back pain at some time in their lives. The most common causes of chronic lower back pain include degenerative disc disease, lumbar facet arthrosis, spondylolisthesis, facet dysfunction, herniated disc, lumbar spinal stenosis, the after-effects of trauma or deformity, among others.
Pain in the lower back, which is usually mechanical in nature.
it can affect up to 80% of the population. In the case of younger people, it is usually caused by trauma and/or inflammation, while among the older population the cause is usually degenerative.
The main diagnostic tools are patient history and physical examination. They can be complemented by scans, which are helpful when considering invasive treatments.
Relative rest, local heat, medication, changes to activity. Once the acute pain episode is over, rehabilitation treatment can begin, with physiotherapy and back school therapy. There are cases where the causes of the pain indicate a need for surgery, and after more conservative therapies have been tried, an operation is required.
X-rays, tomography and MRI
Regular exercise and posture correction.
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