In Utero Surgical Treatment of Spina Bifida

The Maternal-Fetal Medicine Program at Wellington Regional Medical Center features providers who specialize in the treatment of high-risk pregnancies, including babies with spina bifida. From assessment to treatment or surgical intervention, we serve as a resource for families, obstetricians or other maternal-fetal medicine providers treating patients with complicated pregnancies. Our goal is to provide the best possible outcome for the mother and baby.

For a referral to the fetal medicine program at Wellington Regional, please call our free physician referral service at 561-798-9880.

What is Spina Bifida?

Spina bifida, which means “cleft spine,” is a birth defect where the spine and spinal cord do not form correctly, potentially leaving the spine and nerves uncovered.  The opening in the spine can expose the spinal cord and nerves to fluids during fetal development, which can cause damage to those sensitive structures. According to the National Institute of Health, spina bifida is the most common neural tube birth defect in the U.S. affecting an estimated 1,500 – 2,000 births per year. There are an estimated 166,000 people in the U.S. living with spina bifida.

New Prenatal Fetal Surgical Option for Spina Bifida

Wellington Regional Medical Center is one of only two hospitals in the country to be approved for a Phase 1 clinical trial of a fetoscope surgical option to treat spina bifida while the baby is still in the uterus. Ruben Quintero, MD, a fetal medicine surgeon at Wellington Regional Medical Center, collaborated with a team from Brazil to develop the new approach to the spina bifida surgery that is currently under this study.

In the recently developed minimally invasive fetal surgery procedure, physicians can reach the baby and perform the necessary surgery using thin endoscopes through only a few small skin incisions (less than a 1/4 inch long each). The fetoscopic approach is less invasive than open fetal surgery, which requires surgically opening the mother’s abdomen and uterus. By comparison, in open procedures for in utero spina bifida surgery, physicians reach the fetus by surgically opening the mother’s abdomen and uterus.

Studies have shown that performing surgery for spina bifida before birth, instead of waiting until after the baby is born, is better for the baby. The fetoscopic approach is not only better for the current pregnancy, but it also reduces the risk of uterine rupture in subsequent pregnancies since the uterus is not opened. The patient also has the opportunity to deliver future babies through natural methods, not caesarean-section.

Three Main Types of Spina Bifida

Myelomeningocele

Considered the most severe form of spina bifida, babies who suffer from myelomeningocele have a sac of fluid that comes through an opening in the back. Located in the sac are parts of the baby’s spinal cord and nerves and they are often damaged. People who suffer from this version of spina bifida can have issues with walking, feeling their legs or feet or going to the bathroom.

Meningocele

In this version of spina bifida, the spinal cord is not in the sac coming through the opening in the back and there is usually little to no nerve damage. Meningocele often results in less significant disabilities.

Spina Bifida Occulta

This is the mildest version of spina bifida and is usually not discovered until late childhood or even earlier adulthood. With spina bifida occulta, patients do not have a sac or an opening in the back. Sometimes known as “Hidden Spina Bifida,” patients have a small gap in the spine and usually do not have any disabilities from the condition.

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