New Study Shows Effectiveness of Spina Bifida Treatment

Typically, during the first four weeks of healthy fetal development, the two sides of the backbone join together to cover the spinal cord, nerves and meninges. However, if this development does not occur completely, a defect known as spina bifida can result. This defect, characterized by protrusion of the spinal cord through an opening in the spine, often leads to a fluid-filled sac attachment on the back, and ultimately, permanent nerve damage. Some affected individuals have additional complications, including a buildup of excess fluid around the brain.

There is no cure for spina bifida, as the nerve tissue that is damaged or lost cannot be repaired or replaced. However, there are a number of treatments available to help manage the disease and prevent complications. Perhaps most interesting is a remarkable fetal surgical procedure that can be performed on the fetus prior to the 26^th week of pregnancy. In this procedure, a three-inch-wide incision is first made in the pregnant mother’s uterus. The fetus is then surgically positioned so that the spinal defect is exposed and the spinal cord is carefully repositioned. Finally, the spinal cord is covered with membranes and muscle, and the uterus is carefully closed up.

This remarkable procedure has received much attention recently; the Management of Myelomeningocele Study (MOMS) has just completed a study of 183 pregnancies comparing prenatal and postnatal spinal bifida surgeries, showing much success with prenatal surgery. It was found in many cases that in utero operations reduced or even eliminated paralysis and brain damage. In fact, “More than 80 percent of the children who had the surgery after birth needed shunts, compared to 40 percent among those operated on prenatally” (Knox). Shunts are tubes that carry cerebrospinal fluid from the brain to the abdomen, preventing fluid build up in the brain. Additionally, the study showed that children who had the in utero surgery were twice as likely to eventually walk unaided.

Possibly most novel about this study is that it “is the first time that fetal surgery has ever been attempted and validated for what we think of as a non-fatal birth defect” (Farmer). Typically, fetal surgery is not performed unless it is necessary for the survival of the child because it is highly invasive, exposing both the mother and the baby to health risks. However, these recent findings are likely to change the criteria for prenatal surgery in the future.

Article:

http://www.npr.org/2011/02/09/133619351/a-birth-defect-breakthrough-prenatal-spinal-surgery