Total spina bifida aperta is a severe form of spina bifida, a birth defect in which the spinal cord and its protective covering are not completely formed. It is the most severe form of spina bifida and is characterized by an opening in the spine that exposes the spinal cord and its membranes. This can cause a variety of physical and neurological problems, including paralysis, bladder and bowel control problems, and learning disabilities.

The symptoms of total spina bifida aperta can vary depending on the severity of the condition, but may include:

- Paralysis of the lower limbs
- Loss of sensation in the lower limbs
- Urinary and/or bowel incontinence
- Hydrocephalus (fluid buildup in the brain)
- Abnormal curvature of the spine
- Abnormal positioning of the hips and legs
- Abnormal development of the spinal cord
- Abnormal development of the spinal column
- Abnormal development of the vertebrae
- Abnormal development of the spinal nerves
- Abnormal development of the skin covering the spinal cord
- Abnormal development of the muscles and ligaments in the back
- Abnormal development of the bones in the lower back
- Abnormal development of the spinal cord and nerves in

Total spina bifida aperta is caused by a failure of the neural tube to close properly during the first month of pregnancy. This can be caused by a combination of genetic and environmental factors, such as a lack of folic acid in the mother's diet, certain medications, and exposure to certain chemicals.

The treatments for total spina bifida aperta vary depending on the severity of the condition. Generally, treatment includes surgery to close the spinal defect, physical therapy to help with mobility, and medications to manage any associated symptoms. In some cases, additional surgeries may be necessary to correct any associated deformities or to help with bladder and bowel control. Other treatments may include the use of braces or orthotics to help with mobility, and the use of a shunt to help with hydrocephalus.

The risk factors for total spina bifida aperta include:

1. Family history of neural tube defects
2. Low intake of folic acid during pregnancy
3. Maternal diabetes
4. Maternal obesity
5. Maternal use of certain medications, such as anticonvulsants, during pregnancy
6. Maternal exposure to certain environmental toxins, such as pesticides, during pregnancy
7. Maternal age over 35 years old

There is no cure for total spina bifida aperta, but there are medications that can help manage the symptoms. These include medications to reduce swelling, pain, and spasticity, as well as antibiotics to prevent infections. Surgery may also be necessary to repair the spinal cord and close the opening in the spine.