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Treatments and drugs
By Mayo Clinic staffSpina 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.
Surgery
Meningocele involves surgery to put the meninges back in place and close the opening in the vertebrae. 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 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.
Ongoing care
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
Cesarean birth also may be part of the treatment for spina bifida. In many babies with spina bifida, the condition is detected before birth, and cesarean birth may be a safer way to deliver these babies. Delivery before labor begins may diminish the degree of damage to the baby's exposed nerves, so most specialists now recommend a cesarean 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. In this experimental and controversial procedure, which isn't widely available, surgeons expose a pregnant mother's uterus surgically, open the uterus and repair the fetus' 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 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 seem to need fewer shunts, but their walking ability and bowel and bladder functioning don't seem to be improved. And the operation poses risks to the mother and greatly increases the risk of premature delivery.
To get a better idea if there is enough of a benefit to justify the risks, the National Institute of Child Health and Human Development is conducting a large, long-term clinical trial called the Management of Myelomeningocele Study. The study hasn't yet been completed, so for now, it's unclear whether this risky technique is more effective than is traditional surgery to close the spinal column after birth.
- Spina bifida fact sheet. National Institute of Neurological Disorders. http://www.ninds.nih.gov/disorders/spina_bifida/detail_spina_bifida.htm. Accessed July 30, 2009.
- Spina bifida. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/print/sec19/ch292/ch292c.html. Accessed July 30, 2009.
- Spina bifida, March of Dimes. http://www.marchofdimes.com/pnhec/4439_1224.asp. Accessed July 30, 2009.
- Hochberg L. Prenatal screening and diagnosis of neural tube defects. http://www.uptodate.com/index/home.html. Accessed July 30, 2009.
- Ask the doctor archive. Spina Bifida Association. http://www.spinabifidaassociation.org/site/c.liKWL7PLLrF/b.2738091/k.9A71/Risk_Factor.htm. Accessed Aug. 1, 2009.
- Cameron M, et al. Prenatal screening and diagnosis of neural tube defects. Prenatal Diagnosis. 2009;29:402.
- Routine tests in pregnancy. American College of Obstetricians and Gynecologists. http://www.acog.org/publications/patient_education/bp133.cfm. Accessed Aug. 1, 2009.
- FAQs about folic acid. Centers for Disease Control and Prevention. http://www.cdc.gov/ncbddd/folicacid/faqs.html. Accessed July 30, 2009.
- Edwards MJ. Hyperthermia and fever during pregnancy. Birth Defects Research (Part A): Clinical and Molecular Teratology. 2006;76:507.
- Folic acid for the prevention of neural tube defects: U.S. Preventive Services Task Force recommendation statement. Rockville, Md.: U.S. Preventive Services Task Force. http://www.annals.org/cgi/reprint/150/9/626.pdf. Accessed Aug. 24, 2009.
- Harms RW (expert opinion). Mayo Clinic, Rochester, Minn. Aug. 24, 2009.
