Treatment of Spina Bifida
Although treatment cannot cure spina bifida, it can help manage symptoms and prevent infections. The type of treatment a healthcare provider recommends will depend on the type and severity of the disorder, among other things. Options include surgery, braces, crutches, and wheelchairs.
There is no cure for spina bifida; the nerve tissue that is damaged or lost cannot be repaired or replaced. Treatment of spina bifida will depend on the type and severity of the disorder. Although children with the mild form usually do not need treatment, they may require surgery as they grow.
The key priorities in the treatment of myelomeningocele are to prevent infection from developing through the exposed nerves and tissue of the defect on the spine and to protect the exposed nerves and structures from additional trauma.
In most cases, a child born with spina bifida will need surgery within the first few days of life to close the defect and to prevent infection or further trauma.
Doctors have recently begun performing fetal surgery for treatment of myelomeningocele. Fetal surgery, which is performed in utero (within the uterus), involves opening the mother's abdomen (stomach) and uterus and sewing shut the opening over the developing baby's spinal cord.
Some doctors believe that when the defect is corrected early, the outcome for the baby is better. Although this surgery cannot restore lost neurological function, it may prevent additional loss from occurring. However, this surgery is considered experimental, and there are risks to the fetus and the mother.
The major risks to the fetus are those that might occur if the surgery stimulates premature delivery. These risks include:
- Organ immaturity
- Brain hemorrhage
Risks to the mother include:
- Blood loss leading to the need for transfusion
- Gestational diabetes
- Weight gain due to bed rest.
However, the benefits of fetal surgery for the treatment of spina bifida are promising because there will be less exposure of the spinal nerve tissue and bones to the intrauterine environment -- in particular, the amniotic fluid, which is considered toxic.
Doctors have also discovered that this procedure affects the way that the brain develops in the uterus, allowing certain complications (such as Chiari malformation with associated hydrocephalus) to correct themselves. These corrections may lead to the elimination of surgery to implant a shunt.
Many children with myelomeningocele will develop a condition called progressive tethering, or tethered spinal cord syndrome (also known as tethered spinal cord). In tethered spinal cord syndrome, the spinal cord will become fastened to an immovable structure -- such as overlying membranes and vertebrae -- causing the spinal cord to become abnormally stretched and the vertebrae elongated with growth and movement.
This condition can cause loss of muscle function to the legs, bowel, and bladder. Early surgery on the spinal cord may allow the child to regain a normal level of functioning and prevent further neurological deterioration.
(Click Tethered Spinal Cord for more information.)
Some children will need subsequent surgeries to manage problems with the feet, hips, or spine, and some people with hydrocephalus may require additional surgeries to replace the shunt, which can be outgrown or become clogged.