Spina bifida afflicts about 1,500 to 2,000 babies born in the United States each year. This condition is a birth defect that prevents the spinal cord and backbone from developing properly in the womb. Most children born with spina bifida grow up unable to walk, or may only be able to walk with assistive medical appliances. Spina bifida may also cause fluid buildup in the brain, loss of bladder control, and many other possible complications.
Thanks to a revolutionary new surgical procedure, medical professionals may have found a method for lessening the burden spina bifida places on children born with the condition. While surgery has been the primary method of lessening the severity of spina bifida in children, this new procedure takes it a step further and addresses the problem while the baby is still in the womb.
In Utero Spina Bifida Surgery
Surgeons at the Texas Children’s Hospital in Houston recently performed “fetoscopic” surgery on an unborn infant just 24 weeks old. Barely more than two pounds, the tiny baby had a spinal defect, a trademark of spina bifida. Pediatric neurosurgeons made an incision in the mother’s abdomen and lifted the uterus, still attached to the mother, out of her body. Two more small incisions in the uterus allowed the surgeons to insert their instruments to perform the procedure: one is a grasping tool with a telescope and light, the other slit was reserved for the other instruments needed for the procedure.
Previously, many doctors would only attempt such a procedure on a baby that would not survive without intervention. If an unborn child would have died without intervention, then a failed attempt at surgery would only bring about the inevitable conclusion anyway. This new procedure, though still controversial among pediatric medical professionals, may provide a better standard of care than other forms of surgery.
Performing this surgery earlier in fetal development can also help offset the negative effects of spina bifida, lessening the impact of the condition on the child. The exposed nerve tissue in fetuses with spina bifida gradually degrades because of the amniotic fluid. As the baby passes waste into the fluid, the fluid increases in toxicity and damages the unprotected spinal nerves exponentially. By closing the opening earlier, surgeons prevent damage during the rest of pregnancy.
Success Rates of Surgery in Utero
A 2011 study concluded that spina bifida surgery before birth had a greater success rate than surgery after birth. For carefully selected cases, the percentage of children who could walk after birth was 40% in cases of pre-birth surgery, compared to only 20% of cases of post-birth surgery. Additionally, the need for a shunt was only present in 40% of pre-birth surgery cases, compared to 82% of post-birth cases.
The new fetoscopic procedure seems to promise several positive results, including longer-lasting pregnancies for more fully developed babies, a higher chance of possible vaginal delivery, and better quality of life for babies born after the procedure. The doctors at Texas Children’s Hospital performed their procedure in September of 2017, and the baby is due for delivery in January, so time will tell how much this procedure improved the quality of life for this child.
