Spina bifida – Spinal cord surgery factsheet
Introduction
Spina Bifida describes a group of spinal abnormalities resulting in the incomplete development of the spinal cord, the bones of spinal column (vertebrae) and overlying skin. In the most severe form (myelomeningocele), the spinal cord nerves and meninges bulge through an opening in the spine to form a sac outside of the baby’s back. Surgery is performed to correct this defect.
In Spina Bifida (meningocele and myelomeningocele), there is a spinal defect where nerves, tissue and the sac covering are exposed. When they are exposed, they are at risk of infection and additional trauma.
Types of lesions:
- A closed lesion is where the defect is covered by skin.
- An open lesion is where the defect is not covered by skin.
Before the procedure
People living with Spina Bifida and a shunt for hydrocephalus may need to have their shunt function checked first as that may be the cause of functional or neurological changes. A CT scan of the brain may be done to check for this.
During the procedure
The aim of surgery is to put the spinal cord back into the spinal canal, close the defect and overlying skin to prevent infection and protect them from trauma. In an ‘open’ lesion (no skin covering), this is usually done within the first few days of life.
If the lesion is covered by skin, the surgery may be done later, taking into consideration the baby’s age, weight and general condition. This will be discussed with the neurosurgeon on a case-by-case basis.
Management
Complications
Potential complications around the time of surgery include:
- Infection
- bleeding
- difficulty with wound healing
- cerebrospinal fluid (CSF) leak
- damage to the spinal cord.
Long term complications include tethered cord syndrome. Between 20-50% of children with myelomeningocele may develop tethered cord syndrome (with symptoms) after their initial surgery. This is because scar tissue will form around it which can cause the spinal cord to fasten to immovable structures instead of being free to move up and down.
Tethered cords are managed through detethering surgery.
Fetal surgery
Fetal surgery in Australia is currently only being performed at the Mater Hospital in Brisbane. It involves opening the mother’s abdomen and uterus and closing the abnormal defect over the baby’s spinal cord while the baby is in utero. It does not restore lost neurological function but may prevent progressive loss from occurring. The MOMS trial showed that children with Spina Bifida may be more likely to walk independently and less likely to require a shunt after fetal surgery compared with traditional repair after birth, but there were also higher risks of maternal and infant complications.
Major risks of fetal surgery include:
- infection
- blood loss
- prematurity delivery & related complications including brain haemorrhage, organ immaturity and death.
Please discuss with your doctor if you have any questions about fetal surgery and to determine if you meet the criteria.
