Surgery

Surgery is the most common treatment for spina bifida and its complications. Most children with severe spina bifida require a series of operations.

• The first, which usually is done in the first 48 hours of the child’s life, involves tucking the exposed spinal cord and nerve roots back into the surrounding membrane, closing the defects in cord and membrane, and covering the wound with muscle and skin flaps taken from either side of the back.
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• Subsequent surgeries involve correction of deformities. This might include cutting tendons or ligaments to release contractures and/or rebalancing muscles around the involved joint. When regular examinations indicate that the individual’s functioning is declining while a physical deformity gets worse, surgery should be considered.
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Urologic surgery is often necessary, because unresisted contracture limits the ability of the bladder to hold enough urine to space out emptying and may obstruct flow from the kidneys. Untreated, this can lead to kidney failure, which can cause premature death.

In the 1990s, pioneering surgeons developed a technique for repairing the spinal cord while the fetus is still in the womb. The reasoning behind this is that the longer the spinal cord is exposed to outside elements, even in the womb, the greater the possibility for damage to the cord and nerve roots. Thus, earlier surgery could prevent some of the damage that has already occurred by the time the baby is born.

• Preliminary results have been good in that babies who underwent prenatal surgery are less likely than babies who underwent surgery at birth to require a shunt for drainage of hydrocephalus fluid.
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• This surgery is not without risk, of course; like any operation, it carries significant risks. This surgery also sharply increases the risk of premature birth, which entails its own set of risks for the baby.
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• It is too early to tell yet whether this operation is worth the risks it entails. Researchers are observing the children who have undergone this surgery as they grow, to see whether they do better than children who undergo the conventional surgery.
  

Hydrocephalus usually is treated by placement of a shunt. A shunt is a special tube surgically placed in the head and under the skin down into the chest or abdomen. The shunt drains excess fluid from the brain into the abdomen, where it can be eliminated without harm.