Spina Bifida

If your baby is diagnosed with a form of spina bifida, such as myelomeningocele, Dr. Mehra and team can help to carefully plan your baby’s care, using the most advanced treatments available.

Dr. Mehra has extensive expertise performing inutero surgery, which means he operates on you and your baby during pregnancy to repair spina bifida. 

What is spina bifida? 

Spina bifida is a congenital (present at birth) condition that occurs when a baby’s neurologic system (brain and spinal cord) do not develop properly. During early pregnancy, a baby’s brain and spinal cord form from specialized cells known as the neural tube. If the neural tube does not close completely, the spinal bones (vertebrae) don’t completely surround and protect the spinal cord. The spinal cord is exposed through an opening in the spine, which can cause permanent nerve damage.

Types of spina bifida

Spina bifida ranges from mild to severe, depending on the size and location of the neural tube defect.   The most commonly known types of spina bifida are:

• Myelomeningocele (MMC): In this most severe form, the spinal opening typically extends along several vertebrae, and it most commonly affects the lower or middle back. An open sac comes through the spinal defect opening, and contains part of the spinal cord, cerebrospinal fluid (CSF), and meninges (the protective membranes that cover the brain and spinal cord). Myelomeningocele can cause serious complications depending on where the opening is along the spine. These problems can be physical, such as leg weakness or paralysis, or cognitive, such as learning, social and emotional issues.
  
  
• Meningocele: With this type of spina bifida, the sac that comes through the spinal opening contains CSF and meninges, but the spinal cord remains in place inside the spine. With a meningocele, the sac is usually covered by skin. Typically, children are neurologically normal and do not require surgical repair.
  
  
• Occulta: Spina bifida occulta (which means hidden) is the mildest form of spina bifida, involving a small gap in the spine. It usually doesn’t cause neurological symptoms, so many people with spina bifida occulta might not even know that they have it.

What causes spina bifida?

While the exact causes of spina bifida are unknown, scientists believe that a combination of environmental and genetic factors may be involved. Research suggests adequate folic acid intake minimizes risk of spina bifida. Folic acid (vitamin B9, also called folate) is important for your baby’s brain and spinal cord development.

Folic acid occurs naturally in many foods, such as leafy green vegetables, eggs and citrus fruits. Many multivitamins and most prenatal vitamins commonly contain folic acid.

Spina bifida signs and symptoms

Spina bifida does not cause signs or symptoms that women experience during pregnancy. Our doctors can detect signs of spina bifida in a baby before birth, often as early as 14 weeks, using 3D ultrasound.

Signs that can appear during ultrasounds of babies in the womb include:

• Fluid-filled sac protruding from the middle or lower back
• Opening along one or more vertebrae

The effects of spina bifida vary, depending on factors such as:

• How large the spinal opening is
• Where the opening is along the spine
• Whether it is covered with skin
• Which spinal nerves are affected

The signs and symptoms that appear at birth or later in childhood include:

• A patch of hair, birthmark or dimple at the site of the opening (more commonly with spina bifida occulta)
• Developmental difficulties such as learning disabilities, muscle weakness, and bone and joint problems
• Fluid buildup in the brain (hydrocephalus)
• Loss of bladder or bowel control (incontinence)
• Loss of sensation in parts of the body below the spinal opening
• Partial or total paralysis in the legs

How is spina bifida diagnosed?

If your doctor sees signs of spina bifida in a routine ultrasound, you then have more detailed imaging to confirm a diagnosis. Additional images may include:

• Targeted, high-resolution ultrasound
• On-site ultrafast fetal magnetic resonance imaging (MRI)

In addition to high resolution imaging, other tests may also be ordred to confirm a suspected diagnosis.  Those tests may include: 

• Maternal Serum Alpha Fetoprotein (MSFAP) screening
• Amniocentesis 
• High Resolution Fetal Echocardiogram 
• Genetic consultation 

Additional tests that may be required after delivery include: 

• MRI
• CT

Spina bifida treatment

Surgical treatment options for spina bifida include fetal in utero repair of the MMC or postnatal spina bifida repair. When recommending treatment options, Dr. Mehra's team focuses on the health of both mother and baby.  Careful evaluation and diagnostic tests are combined to formulate the best possible clinical approach for each individual family.  By helping families understand thier options, as well as the risks and benefits associated with each intervention, Dr. Mehra and his staff provide guidance and support every step of the way, ensuring the families goals are always the main priority.  

Open fetal surgery for spina bifida/MMC

Dr. Mehra has the surgical expertise to provide in utero spina bifida repair by using the most cutitng edge technology and surgical technique.  Repairing the spinal opening while  baby is still in the womb helps prevent further nerve damage and can minimize the risk of developing hydrocephalus (swelling on the brain), or other complications later in life.

In utero fetal surgery for MMC involves an incision in the mother’s abdomen (belly) and another in the womb to reach the baby, using ultrasound for guidance.  A pediatric neurosurgeon then removes the sac surrounding the MMC and places the spinal cord back into the spinal column. To protect the spinal cord from exposure to the amniotic fluid, the surgeon then closes the tissue and skin over the area.

Dr. Mehra's team will discuss your candidacy for this type of intervention, as there are certain criteria that must be met.  Patients are proivded with all the information they may need to make an informed decision, including recovery and possible impact on the remainder of the pregnancy.  

Post-procedure care involves a 3-5 day hosptial stay, followed by home bedrest, monitoring through outpatient appointments, and delivery by C-section.   Additional considerations in regards to what to expect with in utero surgery will be reviewed in detail, so parents can make the best decision for their family.

Treatment after birth for spina bifida

Dr. Mehra and his team educate families about the safest delivery options for each baby.  Since no two pregnancies are ever the same, it is important that each birth plan is tailored to best suit each individual family.  After delivery,  Dr. Mehra will provide immediate care for your baby and assist in coordinating care at Oak Lawn or Park Ridge Neonatal Intensive Care Units. NICU teams will monitor your baby for development of hydrocephalus and will assess and treat any additional needs.

Follow-up care for spina bifida

Advocate Children’s Hospital provides ongoing, comprehensive care for children who have spina bifida.  Neonatal and pediatric specialists bring together expertise from multiple fields of medicine to treat children from infants through young adults. The Spina Bifida Clinic includes specialty care in:

• Pediatric neurosurgery
• Pediatric urology
• Physical and occupational therapy
• Social work

Please contact Dr. Mehra's team to learn more about Spina Bifida care in Chicago.