Management and Treatment for Spina Bififda

Treatment and management for spina bifida depends on the severity of the condition.


Occulta: This condition usually requires no treatment. Most individuals don’t know they are affected, unless the defect is diagnosed during an X-ray for some other reason. Occasionally newborns are diagnosed with this form of spina bifida if they have a dimple or other marking on their back. In some cases, these babies may need to be evaluated for spinal cord abnormalities that could eventually result in complications, such as weakness or numbness in the legs and bladder problems. Occasionally surgery is recommended to prevent these problems.

Meningocele: This defect is repaired surgically, and affected babies usually have no paralysis.

Myelomeningocoele :

* Children with myelomeningocele, however, require complex and often lifelong treatment and assistance. Almost all of them survive with appropriate treatment starting soon after birth. Their quality of life depends at least partially on the speed, efficiency, and comprehensiveness with which that treatment is provided.

A child born with myelomeningocele requires specialty care.

* The child should be transferred immediately to a center where newborn surgery can be performed.
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* Treatment with antibiotics is started as soon as the myelomeningocele is recognized; this prevents infection of the spinal cord, which can be fatal.
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* The operation involves closing the opening in the spinal cord and covering the cord with muscles and skin taken from either side of the back. The most common complications are tethered spinal cord and hydrocephalus, which can have very severe consequences.
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Each person with severe spina bifida requires intensive and complex care by a trained and coordinated team.

* The care team includes one or more pediatricians, neurologists, neurosurgeons, orthopedic surgeons, physical medicine specialists, endocrinologists, urologists, physical therapists, orthotics specialists, occupational therapists, psychologists, nurses, dietitians, social workers, and other professionals.
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* If at all possible, the individual with spina bifida should receive care at a specialized multidisciplinary spina bifida clinic where all necessary services, which are extensive, can be provided in a coordinated and convenient manner. A list of these clinics throughout the United States is available from the Spina Bifida Association of America.
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There is no cure for spina bifida. The goal of treatment for spina bifida is to allow the individual to achieve the highest possible level of function and independence. Treatment should address any disability, physical, emotional, or educational, that interferes with that person’s potential.

Medical Treatment

After newborn surgery, children with severe spina bifida undergo regular assessment to detect any deformities, developmental problems, or other complications that may require intervention.

* Children should be watched for signs of hydrocephalus, tethered spinal cord, seizure activity, obesity, bowel and/or bladder control problems, frequent urinary tract infections, learning disorders, emotional and psychosocial problems, and other complications of spina bifida.
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* Care at a multidisciplinary spina bifida facility will allow the earliest possible detection of these complications, when treatment is most likely to be effective and prevent further deterioration.
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The focus of treatment is developing strength, mobility, and independence. Many of these children will walk. For others, accessibility is the goal.

* Parents should work with a physical therapist to learn how to exercise the baby’s legs to maximize strength and movement. They should begin these exercises as soon after the first surgery as possible. This not only readies the child for walking, but also prevents osteoporosis due to disuse.
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* Children with spina bifida should be provided with prolonged physical therapy, physical education, or adaptive training while in school.
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* Many children can become mobile by wearing a brace or using crutches or an orthotic. These devices allow the child to function at the best possible level by helping with balance, posture, and control.
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* Additional operations may be necessary to correct problems interfering with walking and other functions.
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* Despite this assistance, some children with spina bifida will never be able to walk independently. These children will use a wheelchair for the rest of their lives.
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Bowel and bladder disorders can cause not only physical problems, but also social problems due to teasing, rejection, and isolation.

* Children can be taught techniques for emptying their bladder and bowels appropriately and independently, thus avoiding embarrassment.
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* For example, use of a plastic tube (catheter) to drain urine from the bladder on a regular schedule can help prevent overfilling, which can injure the kidneys. This technique, called clean intermittent catheterization, is of proven benefit in people with spina bifida.
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Prevention and treatment of obesity is an important aspect of medical care for the person with spina bifida. Education and counseling concerning physical activity and dietary choices can help maintain weight at a healthy level.

Treatment for other complications of spina bifida depends on the nature of the complications. Medications, surgery, physical therapy, or behavioral therapy may be appropriate.



*EXTRA KNOWLEDGE

Doctors have recently begun performing fetal surgery for treatment of myelomeningocele. Fetal surgery—which is performed in utero (within the uterus)—involves opening the mother’s abdomen and uterus and sewing shut the opening over the developing baby’s spinal cord. Some doctors believe the earlier the defect is corrected, the better the outcome is for the baby. Although the procedure cannot restore lost neurological function, it may prevent additional loss from occurring. However, the surgery is considered experimental and there are risks to the fetus as well as to the mother.

The major risks to the fetus are those that might occur if the surgery stimulates premature delivery such as organ immaturity, brain hemorrhage, and death. Risks to the mother include infection, blood loss leading to the need for transfusion, gestational diabetes, and weight gain due to bed rest.

Still, the benefits of fetal surgery are promising, and include less exposure of the vulnerable spinal nerve tissue and bones to the intrauterine environment, in particular the amniotic fluid, which is considered toxic. As an added benefit, doctors have discovered that the procedure affects the way the brain develops in the uterus, allowing certain complications—such as Chiari II with associated hydrocephalus—to correct themselves, thus, reducing or, in some cases, eliminating the need for surgery to implant a shunt.