Spina Bifida

If your baby is diagnosed with a form of spina bifida, such as myelomeningocele, Dr. Mehra and his 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:

Occulta: Spina bifida occulta (which means hidden) is the mildest form of spina bifida, involving a small gap in the spine. Spina bifida occult doesn’t typically cause neurological symptoms, so many people with spina bifida occulta might not even know that they have it.
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 with this diagnosis are neurologically normal and do not require surgical repair.
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. Long term challenges can be physical, such as possible leg weakness or paralysis, or cognitive, such as learning, social and emotional issues.

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 the 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, more detailed imaging will be ordered 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:

Magnetic Resonance Imaging (MRI)
Computed Tomography (CT)

Spina bifida treatment

Surgical treatment options for spina bifida include fetal in-utero repair of the myelomenigocele or postnatal surgical 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 Myelomeningocele (MMC)

Dr. Mehra has the surgical expertise to provide in-utero spina bifida repair by using the most cutting 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 imaging for guidance. Working alongside Dr. Mehra, a pediatric neurosurgeon repairs the spinal defect. In-utero surgical intervention can help reduce the risk of long term complications.

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 hospital stay, followed by home bedrest, monitoring through outpatient appointments, and delivery by cesarean 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. A vital part of each birth plan includes coordination of care with appropriate pediatric specialists 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.