Spina bifida

Incomplete formation of the spine and spinal cord before birth, often found on antenatal scans.

What is it?

Spina bifida is a condition in which the spine and spinal cord do not form completely before birth. In open spina bifida (myelomeningocele) the spinal cord is exposed on the back.

What symptoms can it cause?

Effects depend on the level of the spine involved and may include weakness of the legs and differences in bladder and bowel control. Many babies also develop hydrocephalus.

How is it assessed?

It is often found on antenatal scans. After birth your baby is examined and has scans of the spine and brain. Expectant parents are welcome to meet before the birth.

What are the treatment options?

Open spina bifida is usually closed surgically within the first days of life. Hydrocephalus, if it develops, may be treated with a shunt or ETV.

In myelomeningocele, the spinal cord forms as an open, flat plate (placode) at the back, covered only by a thin fluid-filled sac. The bony arches (laminae) are open.
The thin sac is removed and the placode is gently folded into a tube, to resemble the normal shape of the spinal cord.
The dura, the tough membrane around the spinal cord, is closed over it in a watertight layer.
The muscle and its covering (fascia) on either side are brought together over the repair for extra protection.
Finally the skin is closed, completing a layered repair that protects the spinal cord.

When might surgery be considered?

Closure surgery is advised for open spina bifida, to protect the spinal cord and reduce the risk of infection. Later surgery may be needed for hydrocephalus or a tethered spinal cord.

What to expect from recovery and follow-up

Care continues through childhood with the wider team, including physiotherapy, urology and orthopaedics. As your child grows, the team watches for a tethered spinal cord.

When to seek urgent help

If your child is very drowsy, difficult to wake, has a seizure, repeated vomiting or a severe headache, go to the nearest emergency unit or call 10177. If your child is under our care, also call the hospital switchboard and ask for Dr Labuschagne (Netcare Unitas Hospital 012 677 8000; Nelson Mandela Children's Hospital 010 133 0600). New leg weakness, back pain or changes in bladder control also need prompt review.

Consent forms to read in advance

If surgery is recommended, you are welcome to read the relevant form before your consultation. Dr Labuschagne will go through it and sign it with you at the consultation.