Spina bifida treatment depends on the severity of the condition. Spina bifida occulta often doesn't require treatment at all, but other types of spina bifida do.
Meningocele involves surgery to put the meninges back in place and close the opening in the vertebrae. Myelomeningocele also requires surgery, usually within 24 to 48 hours 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 baby's body and covers them with muscle and skin. Sometimes a shunt to control hydrocephalus in the baby's brain is placed during the operation on the spinal cord.
In this procedure — which takes place before the 26th week of pregnancy — surgeons expose a pregnant mother's uterus surgically, open the uterus and repair the baby's spinal cord.
Proponents of fetal surgery believe that nerve function in babies with spina bifida seems to worsen rapidly after birth, so it may be better to repair spina bifida defects while you're still pregnant and the baby is still in your uterus (in utero). So far, children who received the fetal surgery need fewer shunts, and are less likely to need crutches or other walking devices. But the operation poses risks to the mother and greatly increases the risk of premature delivery.
Discuss with your doctor whether this procedure may be right for you.
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 need further operations for a variety of complications. Many have 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.
Cesarean birth also may be part of the treatment for spina bifida. Many babies with myelomeningocele tend to be in a feet-first (breech) position. If your baby is in this position or if your doctor has detected a large cyst, cesarean birth may be a safer way to deliver your baby.
Oct. 04, 2011
- Spina bifida fact sheet. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/spina_bifida/detail_spina_bifida.htm. Accessed June 28, 2011.
- Lightner DD. Spina Bifida. In: Ferri FF. Ferri's Clinical Advisor 2012: Instant Diagnosis and Treatment. Philadelphia, Pa.: Mosby Elsevier; 2012. http://www.mdconsult.com/books/page.do?eid=4-u1.0-B978-0-323-05611-3..00028-8--sc29020&isbn=978-0-323-05611-3&sid=1180550958&uniqId=266655520-3#4-u1.0-B978-0-323-05611-3..00028-8--sc29020
- Spina bifida. March of Dimes. http://www.marchofdimes.com/pnhec/4439_1224.asp. Accessed June 27, 2011.
- Sandler AD. Children with spina bifida: Key clinical issues. Pediatric Clinics of North America. 2010;57:879.
- Folic acid: Questions and Answers. Centers for Disease Control and Prevention. http://www.cdc.gov/ncbddd/folicacid/faqs.html. Accessed June 29, 2011.
- Spina bifida. Centers for Disease Control and Prevention. http://www.cdc.gov/ncbddd/spinabifida/facts.html. Accessed June 30, 2011.
- Hochberg L. Prenatal screening and diagnosis of neural tube defects. http://www.uptodate.com/home/index.html. Accessed June 30, 2011.
- Routine tests in pregnancy. American Congress of Obstetricians and Gynecologists. http://www.acog.org/publications/patient_education/bp133.cfm. Accessed June 30, 2011.
- Adzick NS, et al. A randomized trial of prenatal versus postnatal repair of myelomeningocele. New England Journal of Medicine. 2011;364:993.
- Surgery on fetus reduces complications of spina bifida. National Institutes of Health. http://www.nichd.nih.gov/news/releases/020911-MOMS.cfm?renderforprint=1. Accessed June 30, 2011.