Treatment:

Genetic counseling may be recommended. In some cases where severe defect is detected early in the pregnancy, a therapeutic abortion may be considered.

After birth, surgery to repair the defect is usually recommended at an early age. Before surgery, the infant must be handled carefully to reduce damage to the exposed spinal cord. This may include special care and positioning, protective devices, and changes in the methods of handling, feeding, and bathing.

Children who also have hydrocephalus may need a ventricular peritoneal shunt placed. This will help drain the extra fluid.

Antibiotics may be used to treat or prevent infections such as meningitis or urinary tract infections.

Most children will require lifelong treatment for problems that result from damage to the spinal cord and spinal nerves. This includes:

• Gentle downward pressure over the bladder may help drain the bladder. In severe cases, drainage tubes, called catheters, may be needed. Bowel training programs and a high fiber diet may improve bowel function.
• Orthopedic or physical therapy may be needed to treat musculoskeletal symptoms. Braces may be needed for muscle and joint problems.
• Neurological losses are treated according to the type and severity of function loss.

Follow-up examinations generally continue throughout the child's life. These are done to check the child's developmental level and to treat any intellectual, neurological, or physical problems.

Visiting nurses, social services, support groups, and local agencies can provide emotional support and assist with the care of a child with a myelomeningocele who has significant problems or limitations.

Support Groups:

See: Spina bifida resources

Expectations (prognosis):

A myelomeningocele can usually be surgically corrected. With treatment, length of life is not severely affected. Neurological damage is often irreversible.

New problems within the spinal cord can develop later in life, especially after the child begins growing rapidly during puberty. This can lead to more loss of function as well as orthopedic problems such as scoliosis, foot or ankle deformities, dislocated hips, and joint tightness or contractures.

Many patients with myelomeningocele primarily use a wheelchair.

Complications:

• Difficult delivery with problems resulting from a traumatic birth, including cerebral palsy and decreased oxygen to the brain
• Frequent urinary tract infections
• Hydrocephalus
• Loss of bowel or bladder control
• Meningitis
• Permanent weakness or paralysis of legs

This list may not be all inclusive.

Calling your health care provider:

Call your health care provider if:

• A sac sticks out of the spine of a newborn infant.
• The child is late in walking or crawling
• Symptoms of hydrocephalus develop, including bulging soft spot, irritability, extreme sleepiness, and feeding difficulties
• Symptoms of menigitis develop, including fever, stiff neck, irritability, and a high-pitched cry