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Fetal Surgery



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Various congenital conditions treated through fetal intervention









Spina Bifida

Spina bifida is a group of congenital defects of the spine developed during fetal stage. During the first month after conception, the embryonic structure called neural tube is formed which eventually develops into the baby's brain, spinal cord and the surrounding bony structure. In case of spina bifida, the lower part of the neural tube does not develop or fuse fully leading to abnormalities in brain or spinal cord. When the spinal column does not close properly around the baby's spinal cord the nerves start to protrude through the opening causing spina bifida.

Spina bifida is a broader term used for various conditions of the spine. The defect may range from very mild form which may not present itself with any symptoms to a severe one causing disability and disrupting the patient's normal life. There are broadly three types of spina bifida which are discussed below.

Spina bifida occulta

It is a very mild and most common form of spina bifida in which one or two vertebrae are left unfused. The portion of the spinal cord that is not enclosed by vertebrae is covered by skin. Occulta means 'hidden' and since the opening is hidden under the skin, the condition is referred as spina bifida occulta. However, in such cases, nerve roots and the spinal cord are not affected and hence, the person remains asymptotic.


In meningocele, the meninges (membranes that surround and protect the spinal cord) protrude through the spinal opening without affecting the spinal cord. Sometimes a layer of skin is formed over the opening. In few cases of meningocele, when the membranes push through the opening, they get filled with the spinal fluid forming a cyst. With this type of spina bifida, one may experience only mild symptoms or in few cases the damage may be very severe.


Myelomeningocele is the most severe form of spina bifida. Myelomeningocele, almost certainly leads to mental and physical disabilities. The severity of the damage depends upon the site of the opening on the spine as the portion that is below the opening becomes dysfunctional. The higher the location of the opening, the greater will be the impact on the functioning of the body.


The symptoms vary depending upon the type of the spina bifida. In case of spina bifida occulta, the child remains largely asymptotic and there may be a birthmark, a patch, a dimple or hair growth on the skin under which the vertebrae is not joined properly. This condition is usually diagnosed during an ultrasound performed for some other purpose.

Meningocele may or may not show any symptoms. Partial paralysis with urinary and bowel problems are usually associated with meningocele. This condition is diagnosed before birth through fetal ultrasound and other tests. This condition is diagnosed when a test called maternal serum alpha-fetoprotein is performed on pregnant woman.


Spina bifida occulta doesn't require any treatment; however other two conditions are always treated surgically. In case of meningocele, surgery involves pushing back the membranes into the place and closing the vertebrates. Babies born with Myelomeningocele are operated within 24 to 48 hours of their birth. The surgery is mainly performed to prevent infection and further damage to the spinal cord. If the baby develops too much cerebrospinal fluid which is known as hydrocephalus, a shunt will be placed as part of the treatment. In recent times spina bifida is also treated through fetal surgery, wherein the uterus is surgically opened to correct the spine defect and immediately closed back. Spina bifida, particularly Myelomeningocele type, requires lifelong medical support as children with such a condition continue to suffer from neurological, orthopaedic and bladder and bowel related problems.

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Collection of Pages - Last revised Date: December 10, 2019