New Diagnosis of Spina Bifida Occulta in a Patient Presenting with Bilateral Hamstring Tightness: A Case Report

Spina bifida occulta represents a limited form of spina bifida. In this condition, the vertebral laminae fail to fuse. Spina bifida occulta can be diagnosed on prenatal ultrasound or after birth on routine x-ray. In most cases, SBO is asymptomatic. Here, we present the unique case of a 30-year-old male who presented with bilateral hamstring tightness of lifelong duration, with low back pain of one year duration. Physical exam was notable for bilateral knee flexion contractures of 20 degrees, reduced lumbar flexion by 20 degrees, hypertonicity of bilateral hamstring muscle bellies, with significant tenderness on palpation of ischial tuberosities. Additionally, three long, dark hairs were present at the level of the L5 spinous process, with asymmetrical gluteal cleft and a port wine stain on the right buttock. XR and MRI confirmed the diagnosis of L5 spina bifida occulta. The patient was referred to spina bifida clinic. Physical therapy including core strengthening and aggressive hamstring stretching significantly improved the patient’s symptoms and functional mobility.