Expert: Dr. J. Shawn Leatherman - 7/26/2006

Question
Hello Dr. Leatherman,

I'm not sure if my question falls within your line of expertise but my family doctor is several hours away and the local walk-in clinic doctor didn't have a clue as to what I was talking about.

I recently began wondering if I have spina bifida occulta.  I have always felt an ache like pain at the base of my back.  I'm now 31 years old and I can't remember a time that I have not felt this pain.  The severity changes if I do certain activities like lying flat on the floor, doing sit-ups, sitting in folding chairs or poorly constructed plastic ones. I have gone to massage therapy and felt horrific pain when they massage the area.

I have a sacral dimple.  It is closed and in the crack of my buttocks just above the anus.  My daughter has the exact same thing.  Originally there was some concern when my daughter was born that she may have spina bifida because of the sacral dimple which lead me to do a little research on sacral dimples and spina bifida.  My daughter does not have SB and they have chalked up the sacral dimple to being a hereditary trait, but my research on spina bifida brought me to reading about spina bifida occulta and I wonder if this is the cause of my lower back ache or perhaps you may have another idea.

Thanks for your time

SerenaRae

Answer
Dear SerenaRae,

Spina bifida is a condition where the posterior elements of the spinal cord do not fuse together properly and therefore leave a cleft in the bone.  This happens in utero and is considered a neural tube defect.  Protrusion of the spinal cord also known as a meningoceale can occur, but this is noticed immediately at birth and surgically repaired.  When the defect is small it is called Spina Bifida Occulta...there is no spinal cord defect only a vertebral defect which is small and maybe filled with cartilage.  This can happen anywhere in the spine, but is mast common at the L5 and S1 vertebra.

According to scientific research, spina bifida occulta does not predispose a person to low back pain, or influence the onset or chronicity of back pain. (Nachemson, A.  The Lumbar Spine-an orthopedic challenge.  Published in the journal SPINE 1:59, 1976.)
I have seen this in my patients frequently on radiographic examination, and sometimes they have multiple vertebra affected, but this is an incidental finding.

As far as sacral dimples being and indication, almost everyone in the population has sacral dimples.  They are a landmark for the sacroilliac joints in the pelvis, and are found in all cultures and races.  If you are looking for a landmark, sometimes a small brown pigmentation can be visualized or a small dark spot of hair at the base of the spine, but this is not a true marker.

If you want to know for sure, the only way to truley diagnose Spina Bifida Occulta is with an x-ray examination of the lumbar spine to include an anteroposterior view and a lateral view.  These are normal x-ray views taken on patients.  The suspicion of spina bifida occulta is not enough to rationalize taking those views though.  If you are having chronic pain, or increasing pain, that would be an indication alomg with a proper physical examination performed by a medical doctor or a chiropractic physician.   

That being said, I firmly believe a chiropractic examination and treatment will help you understand where your pain may be originating from as well as help  alleviate the symptoms and the cause.  I would recommend that you have the area of complaint checked out.  The realization is that back pain can be the result of a multitude of problems, most of which are considered minor and treatable.

Respectfully,
Dr. J. Shawn Leatherman