Spina bifida

Spina bifida is one of a class of birth defects, called neural tube defects. These defects involve damage to the spine and spinal cord.

Treatment

The treatment for spina bifida depends on the severity of the condition. Spina bifida occulta doesn't require treatment at all, while meningocele involves surgery to put the meninges back in place and close the opening in the vertebrae. This surgery usually occurs soon after birth.

Myelomeningocele also requires surgery, usually within several hours to several days after birth. Performing the surgery early can help minimize risk of infection that's associated with the exposed nerves and may also help protect the spinal cord from additional trauma. During the procedure, a neurosurgeon places the spinal cord and exposed tissue inside the body and covers them with muscle and skin. Sometimes a shunt to control hydrocephalus is placed during the operation on the spinal cord. Sometimes the shunt placement isn't needed until weeks or months later.

Treatment doesn't end with the initial surgery, though. In babies with myelomeningocele, irreparable nerve damage has already occurred, and ongoing care from a multidisciplinary team of surgeons, physicians and therapists is usually needed.

Paralysis and bladder and bowel problems often remain, and treatment for these conditions typically begins soon after birth. Babies with myelomeningocele may also start exercises that will prepare their legs for walking with braces or crutches when they're older.

In addition, babies with myelomeningocele may require further operations for a variety of complications. Many suffer from a tethered spinal cord — a condition in which the spinal cord is bound to the scar of the closure and is less able to properly grow in length as the child grows. This progressive "tethering" can cause loss of muscle function to the legs, bowel or bladder. Surgery can limit the degree of disability and may also restore some function.

Caesarean birth also may be part of the treatment for spina bifida. Since many babies with spina bifida are detected before birth, researchers have evaluated the safest way to deliver these babies. There's some evidence that delivery before labor begins may diminish the degree of damage to the baby's exposed nerves, so most specialists now recommend a Caesarean section. This planned birth has another advantage — it allows a pediatric neurosurgical team to be ready for intervention soon after birth.

Prenatal surgery
Researchers are investigating the effectiveness of prenatal surgery for spina bifida. Since 1997, more than 200 fetuses have undergone in utero closure of myelomeningocele through open maternal-fetal surgery. In this experimental and controversial procedure, which is only performed at a handful of hospitals, surgeons lift a pregnant mother's uterus out of her belly and place it on her abdomen, where they are able to cut into the uterus and repair the fetus's spinal cord. The surgery takes place between the 19th and 25th weeks of pregnancy.

Proponents of fetal surgery believe that nerve function in babies with spina bifida seems to worsen throughout pregnancy, so it may be better to repair spina bifida defects in utero. So far, children who received the fetal surgery seem to have better brain functioning and fewer shunts, but their bowel and bladder functioning don't seem to be improved. And the operation poses a substantial risk of death to the fetus from extreme premature delivery.