Orthopaedic Conditons & Treatments

Spina Bifida (Myelomeningocele) Treatment & Surgery

The best treatment and surgery for your child’s spina bifida depends on a number of factors. These include their age, their health history, the type and severity of the disease and their history with other various medications and treatments. Spina bifida, which is a deformity of the spine that happens at birth, affects children at various levels. Myelomeningocele is the most severe form of this disease.

Spina Bifida Diagnosis
Spina bifida can significantly affect a child’s quality of life and can lead to multiple other complications. If you are pregnant or think you are pregnant, it is important to be seen regularly by your doctor to check for any complications during pregnancy. In order to diagnose your child while still in the womb, the doctor will ask a variety of questions. Then, several tests will be performed to find out if the child may be at risk for any diseases:

  • Maternal Serum Alpha-Fetoprotein Test (MSAFP) – This simple blood test is performed on expectant mothers in weeks 16 through 18. The test shows how much alpha-fetoprotein has passed through a mother’s blood stream. If the levels are high, another test is performed to ensure there was not a false positive. If both levels come back high, the doctor will perform more tests to check the health of the baby. This test does not prove the child has spina bifida, but high levels do mean there is a chance that it could be present.
  • Ultrasound – This is another one of the first tests the doctor will perform to get a glimpse at the baby and see how development is progressing. An ultrasound gives an image of the baby inside the mother’s womb and can show signs of spina bifida at a very early stage.
  • X-Ray (Radiograph) – Postnatal tests can also be done to diagnose this disease. An X-ray may be done initially to obtain an image of the bone structure to see how the child has developed.
  • Computer Tomography (CT) Scan – If the doctor suspects a child has the disease, they will likely also order a CT scan to check for levels of fluid in the brain of the child. Often times, this can be a sign of severe cases of spina bifida, such as myelomeningocele.

Nonsurgical Treatment for Spina Bifida
If the type of spina bifida the child has is mild, most children will not require treatment. However, in cases of myelomeningocele spina bifida, the child will likely require many treatments throughout their lifetime, starting from the first days after birth. These treatments make conditions better, but there is no cure for this disease. 

Surgery for Spina Bifida (Myelomeningocele)
In most cases, spina bifida myelomeningocele requires surgery within a few days after birth. While the surgery cannot cure the disease, the aim is to prevent symptoms from worsening over time. The doctor may perform the surgery using the following techniques:

  • Protect the Spinal Cord – Because this disease leaves the spinal cord exposed and open to further injury directly after birth, one of the first surgeries performed after birth is done to close the gap over the spinal cord and reduce the loss of tissue. In many cases a shunt is also placed in the spine to help reduce the amount of fluids that reach the brain.
  • Prenatal Surgery – This is still being widely experimented with and is only recommended in some cases. When a child is known to have spina bifida in the womb, a surgery may be performed in the 26th week of pregnancy to help repair the spine earlier. This surgery involves opening up the uterus and repairing the spine of the fetus. 
The multidisciplinary team of orthopaedic experts at North Shore-LIJ Orthopaedic Institute in New York treats all types of spina bifida (myelominingocele) using the most up-to-date methods. 

Spina Bifida Research
The majority of spina bifida research focuses on prenatal surgery and treating the baby as early as possible to reduce the number of symptoms they will face in their lifetime. There are also studies being done on how the levels of folic acid in a mother’s bloodstream determine the likelihood of a child’s spine developing abnormally in the first trimester.

One of the most well-known research cases on this disease was performed in 2010, through a study called the MOMS. This study looked at 183 expectant mothers with children who were already diagnosed with spina bifida. They conducted tests on the efficacy of performing surgery on the fetus while it was still in the womb. In this study, fetal skin grafts were used to cover the spine in an effort to prevent further exposure to amniotic fluids and reduce the symptoms early on. While there were obvious risks involved with both the mother and child, the benefits were found to far outweigh these risks. The benefits were clear: with reduced hindbrain herniation, reduced need for shunts in post-birth surgery, and the reduced severity of the neurological effects, the study determined this pre-birth surgery a success.

Now, the surgery is being performed more regularly, but tests are still being done to reduce the risks involved for the mother and child. In Germany, a study is ongoing that involves a minimally invasive approach through only five small incisions. This approach has been proven to have similar effects as that performed in the MOMS study and is being tested further.

As research on prenatal surgery is ongoing, it is a good idea for your conversation about it with your doctor to be ongoing as well.           

Rehabilitation Services
The Rehabilitation Network of the North Shore-LIJ Health System is dedicated to providing you and your family with result-oriented, comprehensive rehabilitation services. Our goal is to help you and your loved ones find relief from pain and get moving again after an accident, illness, injury or surgery. We’re your partner in a safe, healthy, more rapid recovery.

The multidisciplinary team of orthopaedic experts at North Shore-LIJ Orthopaedic Institute in New York performs spina bifida surgery as well as a broad range of nonsurgical and surgical treatments for conditions that affect the bones.