Spina Bifida

Treatment Overview

Treatment usually is not needed for spina bifida occulta, the mildest form of spina bifida, and often not for meningocele. Treatment of the severe form of spina bifida manifesta called myelomeningocele depends on the specific problems caused by the spinal defect and may include surgery, physical therapy, and the use of braces and other aids.

Prenatal surgery

Sometimes spina bifida manifesta can be surgically corrected before a baby is born (prenatally). The pregnant woman's uterus is entered with surgical instruments and the fetus's spine is repaired. This surgery, which is only done in specialized medical centers, is relatively new, and it is not yet known how much benefit it provides in the long term. It also poses considerable risk for the fetus and mother and can cause premature birth. Because of these concerns, the surgery is considered experimental. Talk with your health professional about the advantages and risks of this surgery.

Initial treatment

A woman who knows that she is carrying a fetus that has spina bifida manifesta may need to have a cesarean section (C-section). She may choose to deliver her child in a large medical center where neonatal (new baby) surgery can be performed.

For the most severe form of spina bifida manifesta, initial treatment includes surgery to correct the protruding nerves and tissues. Surgery to correct the defect is usually performed within 36 to 48 hours after the baby is born. Depending on the baby's health, surgery may be delayed for up to 6 weeks. Antibiotics are often given to prevent infection from developing inside the spinal cord or brain (encephalitis or meningitis).

Most babies with severe spina bifida have increased fluid around the brain (hydrocephalus). Treatment for hydrocephalus involves surgically installing a drainage tube called a shunt that relieves pressure on the brain by draining excess fluid into the abdomen. This keeps the swelling from causing further damage to the brain. A shunt may be necessary for the rest of the child's life. Its placement is usually a simple procedure.

Some babies also have a condition called a Chiari malformation of the brain. In a Chiari malformation, the lower part of the brain presses on the bones of the lower part of the skull and the upper spine. Pressure on the brain can sometimes be relieved with surgery to remove some of the bone.³

In the first few weeks of life, a baby with severe spina bifida may need physical therapy to help strengthen the muscles by exercising the arms and legs. The parents will then continue to help their baby do the exercises at home.

Ongoing treatment

Nerve damage from spina bifida can lead to foot deformities, such as clubfoot, and hip deformities. Treatment of clubfoot may involve using a cast for the first 3 to 4 months of life to gradually straighten the foot. Corrective surgery may then be done by the time the child is 1 year of age. Hip deformities may be corrected surgically. But doctors recommend the surgery only if it is likely to allow the child to walk.

Leg braces may be needed when the child is old enough to walk. These help prevent damage to the joints and help the child walk.

Curvature of the spine—scoliosis, kyphosis (hunchback), or both—may be treated with a brace. But the curvature may get worse as the child grows. Severe curvature needs to be corrected surgically.

Bladder problems resulting from nerve damage can prevent complete emptying of the bladder, which can lead to kidney damage. Insertion of a urinary catheter several times a day (clean intermittent catheterization, or CIC) is done to ensure the bladder gets completely emptied.

Bowel problems are common in spina bifida. Nerve damage can keep the muscles of the digestive tract from squeezing properly to move contents through the intestines and can also keep the muscle around the anus from closing tightly. In addition, there may not be normal feeling (sensation) to let the child know when he or she needs to go to the bathroom or when he or she has had a bowel movement. Parents usually begin working with the doctor or nurse on managing bowel care as soon as the child starts eating solid food.

Some children have problems if scar tissue attaches the spinal cord to other tissues. The scar tissue holds the lower end of the spinal cord in place so the cord stretches as the child grows. This is called a tethered spinal cord. It can cause or increase problems with movement, bladder and bowel control, and pain. Some children will have repeat surgery to release the scar tissue and free the end of the spinal cord.⁵

Frequent doctor's visits will be needed early in the child's life. Doctors recommend that babies with spina bifida manifesta be checked once or twice a month during the first 6 months of life, then 2 to 3 times a month from age 6 months to 1 year. After the baby is 1 year old, doctors recommend visits 2 to 4 times a year. Doctors use these visits to make sure that treatments are working and to determine whether the child needs additional surgery.

A baby with spina bifida manifesta may need ongoing physical therapy to help strengthen the muscles by exercising the arms and legs. You will be able to help your baby do many of these exercises at home.

Treatment if the condition gets worse

Other problems can occur with spina bifida and may get worse as the child grows:

• Curvature of the spine—scoliosis or kyphosis (hunchback)—may need to be corrected with surgery.
• Depending on the location of the nerve damage, walking may become increasingly difficult, and the child may eventually require a wheelchair for mobility.

People whose spina bifida causes them to have an abnormal walking pattern (gait) are more likely to develop arthritis of the hips or knees as they age.

Complications associated with spina bifida that can develop include:

• Skin infections if sensation to injury is diminished. Prevent infections by daily examining your child's skin.
• Urinary tract infections because of difficulty emptying the bladder. Keeping the bladder emptied with clean intermittent catheterization (CIC) may be necessary.
• Constipation because of nerve injury affecting the bowel. Be certain your child drinks enough water. Your doctor may recommend that your child also take stool softeners.
• Latex allergy, which is common in children who have spina bifida. Latex is a natural rubber product that is used to make objects such as toys and health care supplies. Do not allow your child to come into contact with items that contain latex.

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Author:	Shannon Erstad, MBA/MPH	Last Updated: May 10, 2007
Medical Review:	Michael J. Sexton, MD - Pediatrics Colin Chalk, MD, CM, FRCPC - Neurology
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