Children with more severe forms of spina bifida, such as myelomeningocele, may require one or more orthopedic procedures as they grow older. Nerve damage caused by an underdeveloped spinal column can lead to a loss of muscle function, and the tendons that attach muscles to bones may become stiff. Over time, these stiff connective tissues may pull bones out of position, causing discomfort, impaired function, or deformity in the foot, ankle, spine, or hip.
Orthopedic surgeons at Hassenfeld Children’s Hospital at NYU Langone have experience performing a range of procedures, and recommend intervention if they have determined that surgery can improve a child’s long-term prognosis. They work closely with rehabilitation specialists to evaluate each child’s physical potential and determine whether surgery may be beneficial.
Surgery is not exclusively performed to help a child walk. In some instances, your child’s doctor may recommend a procedure to help him or her sit comfortably or to prevent a bone deformity from worsening. In other cases, surgery may restore function in a joint or limb.
If surgery is performed, our doctors collaborate with pain management specialists, physical therapists, and social workers to support children and their families during recovery.
Many children with spina bifida develop foot problems, such as clubfoot, as shortened tendons in the ankle pull the bones out of position. Orthopedic specialists may recommend one or more procedures to lengthen tendons and correct the position of muscles and bones in the feet. These procedures can help reduce pain and may improve a child’s ability to walk.
Our doctors may perform a procedure to release, or lengthen, the Achilles tendon if your child’s foot is pulled into an unusual position and has a limited range of motion. This procedure can be performed in the doctor’s office in just a few minutes.
Before surgery, the doctor injects a local anesthetic into the foot. He or she then makes a small incision in the back of the foot and cuts the Achilles tendon. No stitches are required to close the incision. The doctor then covers your child’s foot and leg with a plaster cast, which is worn for about three weeks.
The position of the cast allows the Achilles tendon to grow back longer, improving range of motion. By the time the cast is removed, the tendon has already healed.
An Achilles tendon release may be performed in combination with a treatment called serial casting, in which the doctor applies a new cast to the foot every week, gradually moving the foot into the correct position. Serial casting may be recommended for six to eight weeks before the Achilles release procedure, or it may continue for several weeks after the procedure.
Some foot misalignments persist after treatment with physical therapy or tendon release surgery. In this instance, doctors may recommend another procedure called Achilles tendon lengthening. This procedure allows your child’s foot to stretch and grow in the right position.
Achilles tendon lengthening takes place in the hospital and is performed using general anesthesia. An orthopedic surgeon makes small incisions at the back of your child’s foot to reach the Achilles tendon. The doctor then gently stretches and cuts the tendon, lengthening it and moving it into the correct position. The incisions are closed using one or two stitches, which dissolve on their own after five days. You can expect to take your child home that day, and most children don’t experience much discomfort.
Immediately after surgery, the doctor applies a cast to your child’s foot and lower leg, allowing for some movement. It’s worn for a minimum of four weeks, or until your child’s doctor determines the Achilles tendon has healed. The doctor may recommend that your child wear a splint or hard boot for an additional period of time after the cast is removed, depending on your child’s age and his or her level of mobility.
Changes in the shape of the spine may occur in children with spina bifida if the muscles that stabilize the small bones, called vertebrae, become weak. These changes can lead to conditions such as scoliosis, an overcurvature in the spine that can affect a child’s balance while standing or sitting. If the curve is severe, the spine may press on the ribcage, which can damage the heart or lungs.
Our surgeons can perform a procedure to straighten and stabilize the spine in children with scoliosis. This may require the removal of vertebrae or the permanent binding of two or more vertebrae together, called spinal fusion. Surgeons may use metal screws or plates to hold the spine in place and prevent the curve from returning as a child grows.
Spine surgery is performed using general anesthesia and takes place in a hospital. Doctors recommend that children remain in the hospital for several days after surgery for observation. Our pain management specialists are available 24 hours a day to ensure that he or she remains comfortable.
After your child is discharged from the hospital, doctors recommend physical therapy.
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