Which form is the most severe type of spina bifida, with extensive spinal opening and exposure of CSF, meninges, and nerve roots?

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When a spinal defect is open and neural tissue is exposed, this describes myelomeningocele, the most severe form of spina bifida. In this condition, the spinal cord and nerve roots herniate through a vertebral opening along with the meninges and CSF, so neural tissue is part of the protruding sac. This leads to significant neurologic impairments below the level of the lesion and is frequently accompanied by other complications such as hydrocephalus and Chiari II malformation.

In contrast, spina bifida occulta involves no protrusion at all and usually little to no symptom; spina bifida meningocele involves protrusion of meninges and CSF without the spinal cord or nerve roots in the sac; and spina bifida cystica is a broader term that can describe protrusion with meninges and CSF, but the involvement of neural tissue in the sac marks the most severe form as myelomeningocele.