Spina Bifida

Treatment

Many parts of the body and nervous system can be affected when a child has spina bifida. A child may need to see numerous physicians and therapists for follow-up. In addition to surgery, physical therapy and early intervention, a child with spina bifida may need treatment for incontinence (inability to control urine and bowel movements) as well as bracing for the legs or spine. With proper medical care, children with spina bifida can lead active and productive lives.

Spina Bifida Clinic

Mayo Clinic in Minnesota has a specialized Spina Bifida Clinic to coordinate the multispeciality care these children need. The specialists have extensive experience treating children with spina bifida and set aside time in their schedules for spina bifida patients. Appointments are coordinated so that multiple doctor visits and testing can be completed in a single visit, spread over several days. Communication among medical team members is enhanced when physicians from various specialties see the child at the same time.

The team of medical experts include pediatric specialists in Neurosurgery, Neurology, Medical Genetics (inherited diseases), Urology, Orthopedic Surgery, Physical Medicine and Rehabilitation and Radiology.

Goal of Treatment

The primary goal of managing spina bifida is to prevent infection and further injury to the exposed spinal cord and nerves.

Management of spina bifida is determined by the child's treatment team based on:

• The child's age, overall health and medical history
  
• The extent of the condition
  
• Expectations for the course of the condition
  
• The opinion or preference of the parent(s)

Treatment Options

Surgery
An infant born with a myelomeningocele (a protrusion of the spinal cord and its coverings through an open defect in the skin of the back) will require surgery soon after birth to close this abnormality.

Often an infant born with a myelomeningocele will also have associated hydrocephalus (an enlargement of the head due to pressure from trapped cerebral spinal fluid). This condition may require placing a shunt (tube) to drain the excess fluid.

During the surgery, a neurosurgeon places the spinal cord and exposed tissue inside the body and covers them with muscle and skin. A plastic surgeon is occasionally needed when a large area is involved which is difficult to close.

Many babies with myelomeningocele have spinal cords that cannot grow properly as the child grows. This progressive "tethering" can cause loss of muscle function to the legs, bowel or bladder. Surgery on the spinal cord may allow the child to regain a normal level of functioning.

Women who know that they are carrying a baby with spina bifida may require a cesarean section (C-section). At Mayo Clinic, this decision is made jointly by the patient and physician.

Physical Therapy

In babies who have myelomeningocele, irreparable nerve damage has already occurred. As soon after surgery as possible, a physical therapist teaches parents how to exercise their baby's legs and feet to prepare for walking with leg braces and crutches. These help prevent damage to the joints and help the child walk.

Urology Services

A urologist usually evaluates bladder functioning of children who have spina bifida. If problems exist, regular catheterization (insertion of a small tube into the bladder to drain urine) may be recommended.