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Surgery before birth: Hope for children with spina bifida (exposed spinal cord)

Spina bifida is the most prevalent birth defect involving the central nervous system (consisting of the brain and spinal cord) affecting about 1,500 babies annually or as many as one out of every 800 infants in the United States. In this condition, the spinal cord and its covering protrude out of the backbone (the most severe and frequent form is called myelomeningocele) so that a sac sticks out under the skin in the mid- to lower back. This results from failure of the spinal column to close while the fetus is developing inside the womb.

Children born with spina bifida will have lifelong weakness or paralysis in the lower extremities, bladder and bowel problems, hydrocephalus (accumulation of fluid in the brain) and mental deficits. Studies show that exposure of the neural tissue (spinal cord and/or its covering) to amniotic fluid (which cushions the fetus) and other elements of the uterine environment results in neurologic deficits such as motor, sensory and cognitive impairments.

A landmark study sponsored by the National Institutes of Health conducted at fetal surgery centers the Children's Hospital of Philadelphia, Vanderbilt University and the University of California, San Francisco – and published in the New England Journal of Medicine followed 158 patients who underwent prenatal fetal surgery. Results showed that babies who received myelomeningocele repair while inside the womb have better outcomes than those who had surgery shortly after birth.

Prenatal surgery is performed by repairing the myelomeningocele with the fetus' own tissue. The findings revealed that the procedure, when done before 26 weeks of gestation, decreases the risk of death and increases the likelihood of the child being able to walk. And by one year of age, the child may no longer need a shunt, a drainage that is surgically implanted to divert fluid in the brain into the abdominal cavity, thus lowering pressure in the head (the spinal cord and the brain are bathed in cerebrospinal fluid). A leakage of the fluid in the spinal column could lead to hernia, or protrusion of the lower part of the brain into the spinal canal. This blocks the normal flow of fluid within the brain, leading to hydrocephalus characterized by enlargement of the skull.

Lead author N. Scott Adzick, MD, Surgeon-in-Chief at the Children's Hospital of Philadelphia and Director of Children's Hospital's Center for Fetal Diagnosis and Treatment, said that the success in prenatal fetal surgery may pave the way for its application in the other critical congenital anomalies.

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Capital Surgeons Group is a group surgical practice specializing in bariatric surgery, breast surgery, colorectal surgery, laparoscopic surgery and robotic surgery at the following locations:

Central Austin

3705 Medical Parkway, Suite 250 and 210
Austin, TX 78705
Appointments: 512.302.1210
Office Hours: M-F, 8:00 am to 4:30 pm

North Austin/Round Rock

505 W. Louis Henna Blvd., Suite 220
Austin, TX 78728
Appointments: 512.498.4860
Office Hours: M-F, 8:00 am to 4:30 pm

South Austin

5625 Eiger Road, Suite 230
Austin, TX 78735
Appointments: 512.441.7755
Office Hours: M-F, 8:00 am to 4:30 pm