Spina bifida treatment
Spina bifida is a neurosurgical condition due to a congenital spine-development disruption. Depending on the severity, the disease might provoke muscle weakness, paralysis, and skeletal deformity. Typically, it is diagnosed during pregnancy screening with an ultrasound. Then, doctors advise undergoing surgical treatment to correct the opening in the spine.
Spina bifida is a group of congenital conditions characterized by a disorder of the normal development of the spinal cord and vertebrae. Often spinal opening leads to problems in the musculoskeletal system and further development.
In the embryonic period, when a baby evolves in the womb, the brain and spinal cord develop from the neural tube. However, the tube does not close entirely, causing spinal issues. One of the areas of the spine remains open. As a result, there is a hole in the spinal canal, with a cerebrospinal fluid leak, the exit of the meninges (spinal cord walls) or spinal nerves and hydrocephalus.
Spina bifida can affect every segment of the spine (cervical, thoracic, lumbar, sacral); despite this, most cases of spinal issues are diagnosed at the lumbosacral level (85% of cases). And only in rare cases, the disease affects the thoracic and cervical regions (15% cases). According to statistics, about 1,500 children are born with such conditions annually. Females are more sensitive to the spinal opening.
Neurosurgeons determine several varieties of the disorder:
- Spina bifida occulta is the least hurtful and the most common type. It is usually asymptomatic and discovered incidentally, so-called hidden. Typically does not require any treatment.
- Closed neural tube defects break the development of the spine's structures (bone and fatty tissue, membranes). This disease either provokes no symptoms or causes minor signs. Sometimes a dimple or a tuft of hair is visible at the site of the defect.
- Meningocele is the least common form and results in motor and mental impairment.
- Myelomeningocele is the most severe form, accompanied by motor (paralysis) and intellectual impairment. There are also problems with urination and intestine. Neurosurgeons report the development of hydrocephalus along with myelomeningocele. The main feature of myelomeningocele is a saccular protrusion filled with fluid.
The disease affects only that part of the body where it happened or below this area. For example, in the case of lumbar spina bifida, the child will suffer from issues below this level. At the same time, it does not affect the hands or organs above (heart, brain, chest).
What are the causes of spina bifida?
The reason for this spinal opening is not a single factor. Usually, it is the result of a combination of several aspects:
- Genetic (the presence in the family of spina bifida increases the risk of the disease).
- The mother's condition before birth and during pregnancy (folic acid deficiency).
- The effect of drugs on the child during pregnancy.
- Obesity or diabetes in the mother.
Typical symptoms of spinal opening in children
Signs and symptoms of spina bifida depend on the severity of the condition. The spina bifida occulta is usually asymptomatic because it does not involve the nerves. However, sometimes people might have a slight asymmetry of the legs, a small dimple or a spot at the site of the lesion.
With meningocele, symptoms are more prominent, including herniation, paralysis, decreased muscle strength, limb deformity, hydrocephalus, and seizures.
As the most severe type, myelomeningocele has pronounced and significant symptoms. There is a protrusion of the sac with the meninges and the spinal cord. Signs include lack of bladder and bowel control, seizures, paralysis and severe muscle weakness, deformity of the pelvis, knees, feet, scoliosis, and difficulty walking.
At the same time, a family should be aware that the disease increases the risk of contracting illnesses, such as meningitis (the infection will enter the spinal cord through the opening).
How to diagnose spina bifida?
Early spinal opening detection is essential for further treatment and prognosis. Thanks to modern diagnostic methods, this defect is diagnosed even before the birth of a child (prenatally). Prenatal screening consists of fetal ultrasound and maternal serum fetoprotein analysis (specific tests to suspect the disease). Additionally, the doctor may perform an amniocentesis.
Fetal ultrasound is a method that does not threaten the baby and is performed at least three times during pregnancy. This procedure uses high-frequency sound waves to visualize the body's structure and helps identify anomalies.
Blood test for AFP (alpha protein). As a rule, the analysis is done between 16 and 18 weeks. Then, physicians take a blood sample from the mother. If the AFP level is elevated, the child may have a neural tube defect.
Doctors can detect the level of alpha protein with amniocentesis. The physician takes a sample of amniotic fluid (liquid surrounding the baby during pregnancy) and examines it for AFP levels.
Despite accurate diagnosis before birth, postpartum (after birth) diagnosis plays an equally important role. In babies after childbirth, the following signs of mild spina bifida may be detected: a tuft of hair, a small hole, or a birthmark at the spine. Doctors use imaging techniques to picture the spinal cord and spine. These are methods such as X-ray, CT or MRI.
What treatment is available for spina bifida?
Therapy options depend on the type of spinal issues. Spina bifida occulta does not require any therapy, as we mentioned before. It causes no symptoms or complications, so doctors follow up with the patient.
Operation is the only proven method to cure spinal openings. In addition, surgery is carried out for severe defect forms (meningocele and myelomeningocele).
Prenatal surgery. The procedure is to close the opening to keep the spinal cord functioning and prevent infection. As a rule, at the birth of a child with myelomeningocele, neurosurgeons operate no later than the first 48 hours. Prenatal surgery is the operation on a child in the womb (before the 26th week of pregnancy). Doctors repair the cleft in the spinal cord through an incision in the uterus.
Postnatal surgery. In the case of childbirth with myelomeningocele and with the presence of a hernial sac, the operation is performed in the first two days.
At the same time, if the disease is detected in adulthood, surgery is indicated only in case of neurological difficulties (severe neurological symptoms). Therefore, the primary treatment at an older age aims to prevent and eliminate complications, and the operation is performed as a last resort. For example, hydrocephalus accompanying spina bifida may require a shunt procedure. In addition, orthopedists eliminate such consequences as dislocations, fractures, and scoliosis. Sometimes a Chiari type 2 malformation is associated with a spina bifida. Such a defect is also treated surgically.
Kids with spina bifida may need long-term care and recovery periods. Neurological or orthopaedic rehabilitation can help make your daily life easier. In addition, physical and occupational therapy helps with leg weakness after surgery and aims to become more independent.
What to expect for someone diagnosed with spina bifida?
The prognosis of spina bifida depends on the degree of damage to the spinal cord and the presence and severity of associated complications. In most cases, the forecast is good. With proper neurosurgical supervision, constant care and rehabilitation, long and healthy life is ensured.
However, survivorship is worse for people with high spinal cord involvement (thoracic or cervical) and patients with paralysis, hydrocephalus, or Arnold-Chiari anomaly.
What age is the best for spina bifida surgery?
Age up to 26 weeks of pregnancy. Prenatal surgery (surgery in the womb) is performed for up to 6 months of pregnancy, preventing the defect's further development and possible complications. However, doctors can also perform the surgery after childbirth.
Can I treat spina bifida without surgery?
Yes. The spina bifida occulta does not require surgical treatment. Unfortunately, for other forms of the disease, surgery is the primary choice, carried out during pregnancy or within 24-48 hours after the child's birth.
What is the success rate for spina bifida surgery?
Fetal surgery has a high success rate. For example, in clinics modern abroad, the success rate of surgical treatment of meningocele and myelomeningocele ranges from 86 to 91%.
Why can spina bifida treatment abroad be better?
Treatment of spina bifida abroad has several advantages: the operation is performed by a multidisciplinary team of doctors (neurosurgeons, obstetricians, neonatologists, orthopedists); during the surgery, constant monitoring of the condition of the mother and child is carried out; minimal risk of complications after surgery; modern methods of rehabilitation.
Is spina bifida a curable disease?
No. Spina bifida is a disease for life. Surgical methods and long rehabilitation improve the patient's condition, prevent complications and often relieve severe disability.
Where can I get Spina bifida treatment?
What are the best clinics for Spina bifida treatment?
Who are the best doctors for Spina bifida?
Prof. Dr. med. Bernhard Meyer from University Hospital rechts der Isar Munich
Dr. med. Peter Madjurov from Academic Hospital Bundeswehr Berlin
Prof. Dr. med. Thomas Gasser from Beta Clinic Bonn
Prof. Dr. med. Marcus Czabanka from University Hospital Frankfurt am Main of Goethe-University
Prof. Dr. med. Jorg-Christian Tonn from University Hospital Ludwig-Maximilians Munich