Early Intervention for Newborns with Spina Bifida

Pediatric specialists at Hassenfeld Children’s Hospital at NYU Langone understand that spina bifida affects every child differently and that some babies need specialized treatment. Children with the mildest form of spina bifida, spina bifida occulta, rarely need treatment. Babies with more severe types, such as myelomeningocele and meningocele, require immediate care after birth.

Doctors aim to prevent infection and limit damage to the spinal cord, which processes sensory information and controls movement.

The Neonatal Intensive Care Unit (NICU) is staffed with board-certified intensive care specialists who can care for your baby 24 hours a day. Our NICU provides expert care in a supportive, family-centered environment. Parents are welcome to accompany our doctors on daily rounds while your baby is in the NICU, giving you the opportunity to hear about treatments that may be used and ask questions about your baby’s long-term care and prognosis.

Parents are also invited to participate in weekly meetings with doctors who specialize in neonatology, neurosurgery, orthopedics, urology, rehabilitation medicine, and social services.

Whether your baby is diagnosed before birth or shortly after delivery, our team of neonatal specialists creates a care plan to address your baby’s needs. Some surgical treatments, such as neurosurgery to restore displaced spinal cord tissues, are performed in the first few days after birth. Our pediatric neurosurgeons, who treat nervous system disorders, determine when intervention is needed.

Spinal Cord Surgery

If your baby has myelomeningocele or meningocele, in which a sac of tissue emerges from an opening in the spinal column, neurosurgery may be needed within the first few days after birth. Early intervention may help preserve nerve and muscle function and prevent the opening from becoming infected.

Spinal cord surgery is a complex procedure that may last several hours. For babies with meningocele, surgeons remove the fluid-filled sac, or cyst, on a baby’s back. For babies with myelomeningocele, the surgeon performs a procedure to place the protruding spinal cord in the spinal column, reconstruct the meninges and other tissues, and close the gap in the skin. These procedures are performed using general anesthesia.

For Pediatric Hydrocephalus

If the results of diagnostic imaging tests such as an MRI or ultrasound reveal a buildup of fluid in and around a baby’s brain, which is called hydrocephalus, doctors may recommend a procedure to remove the fluid and relieve pressure. 

In this procedure, a surgeon implants a shunt, a long, thin tube that drains fluid from the brain and carries it to the abdomen, where it is absorbed. A neurosurgeon may perform this procedure at the same time as spine surgery. 

For a Chiari Malformation

Some babies with spina bifida, in particular myelomeningocele, are born with a Chiari malformation, in which part of the brain pushes into the spinal canal. This puts pressure on the brain or spinal cord and causes symptoms such as difficulty swallowing and muscle weakness in the upper arms. A doctor may recommend neurosurgery to reduce or eliminate the pressure and relieve symptoms. 

This procedure, called decompression, may result in improved muscle function, reduced pain, and a better long-term prognosis. A surgeon performs decompression using general anesthesia. He or she makes an incision in the back of the head and removes a small piece of skull. Often, this is enough to relieve pressure on the spinal cord. 

After the bone fragment has been removed, the surgeon evaluates whether pressure remains. If so, he or she may open the dura, the tissue that covers and protects the spinal cord. This procedure further decompresses the spinal cord. 

For a Tethered Spinal Cord

Neurosurgeons may intervene soon after delivery or later in childhood if your baby has a tethered spinal cord—when the cord remains attached to tissue near the lower spine instead of hanging freely within the spinal column. As your baby grows, the spinal cord stretches, damaging spinal cord tissue and causing pain, muscle stiffness, uncontrolled movement, and bladder or bowel problems. 

If an MRI reveals that your child has a tethered spinal cord and your child experiences symptoms, neurosurgeons may recommend a procedure to release the spinal cord. In some instances, this is a simple procedure in which a surgeon snips the strand of tissue connecting the spinal cord to the lower spine. 

If the spinal cord is tethered by a complex group of fatty tissues, a surgeon may use laser microsurgery to detach or loosen the spinal cord. Laser microsurgery selectively removes tiny sections of the fatty tissue while avoiding damage to the underlying spinal cord and nerves.