Prenatal Surgery for Spina Bifida: Repairing the Spine Before Birth

For families facing a diagnosis of spina bifida, a new hope is emerging: the possibility of repairing the spinal defect before a baby is born. Advances in fetal surgery are changing what’s possible, offering potential benefits over traditional postnatal repair.

Understanding Spina Bifida

Spina bifida is a congenital central nervous system malformation that occurs when the neural tube doesn’t fully close during pregnancy, typically by 28 days of gestation [1]. This results in a defect in the bony spine, and in the most severe form, myelomeningocele (MMC), part of the spinal cord and surrounding nerves protrude through an opening in the back [1]. MMC is the most common and severe form of spina bifida.

The exposed spinal cord is vulnerable to damage from amniotic fluid, leading to potential lifelong challenges, including weakness or paralysis in the legs, difficulty walking, bladder or bowel problems, and hydrocephalus (fluid buildup in the brain) [3].

Traditional vs. Prenatal Repair

For many years, the standard treatment involved surgically closing the defect after birth. However, because the spinal cord is exposed to amniotic fluid during pregnancy, inflammation can cause nerve damage over time [3]. Prenatal surgery aims to mitigate this damage by intervening while the baby is still in the womb.

How Prenatal Surgery Works

Fetal surgery for myelomeningocele is a delicate procedure. In open fetal surgery, surgeons open the uterus and directly close the opening in the baby’s back [1]. A newer technique, fetoscopic spina bifida repair, utilizes a camera and specialized instruments inserted through small openings in the uterus to close the spinal cord in three protective layers [3].

Benefits of Prenatal Surgery

While not a cure, studies suggest that repairing the spinal defect before birth can offer better outcomes than postnatal repair [1]. Open fetal surgery has been shown to greatly reduce fluid buildup in the brain and improve the chances that a child will be able to walk independently [1].

Who is a Candidate for Fetal Surgery?

Fetal surgery for spina bifida is a complex procedure and is not available to all patients [1]. It requires a significant commitment from mothers and a high level of surgical expertise.

The Future of Spina Bifida Treatment

Ongoing research is exploring emerging regenerative approaches to complement prenatal repair and further improve outcomes for children with spina bifida [4]. As techniques continue to advance, the prospect of minimizing the lifelong challenges associated with this condition becomes increasingly promising.