Children with Spina Bifida may require many different orthopaedic procedures to help treat and manage the condition. For children with scoliosis this may involve spine surgery which, despite being generally safe, carries some risks including surgical failure. Here we outline the key facts and treatments for this condition, together with advice for parents and guardians of a child that has suffered complications in surgery.

What is spina bifida?

Spina bifida is a birth defect that occurs when the spine and spinal cord don’t form properly during early stages of pregnancy. It’s a type of neural tube defect, resulting from the incomplete closure of the spinal column. The severity and symptoms of Spina bifida can vary. The mildest form is spina bifida occulta, where one or more vertebrae are malformed but the spinal cord remains unaffected. A more severe form is meningocele, where the protective membranes around the spinal cord (meninges) bulge out through an opening in the vertebrae. The most severe type is myelomeningocele, where both the membranes and a portion of the spinal cord protrude at birth, forming a sac that’s exposed on the baby’s back. This can result in nerve damage and various disabilities.

How is spina bifida treated?

Spina bifida treatment varies based on its severity and type. For the most severe form, myelomeningocele, surgery is often performed within the first few days of life to close the opening in the back and minimize the risk of infection or further injury. In some cases, prenatal surgery might be an option to close the spinal opening. This can reduce the risk of complications and improve outcomes. Additionally, many children with spina bifida develop hydrocephalus (excess cerebrospinal fluid in the brain). To treat this, a surgical procedure to insert a shunt can divert fluid from the brain to another part of the body.

Throughout their lives, individuals with spina bifida may need treatments for associated conditions, including physical and occupational therapies to address mobility and daily living challenges. Orthopaedic interventions can help with bone and joint issues, while urological care might be required for bladder and bowel problems. Regular medical evaluations are necessary to address potential complications. While there’s no cure for spina bifida, with appropriate care, many people with the condition lead active and fulfilling lives.

What sort of orthopaedic procedures are used for children with spina bifida?

Some orthopaedic procedures that may be utilised in a treatment plan for children include the following:

• Tendon Releases or Lengthening – Tight tendons, often resulting from muscle imbalances, can lead to joint contractures. Surgeons may lengthen or release these tendons to improve range of motion and function.
• Osteotomies – This involves cutting and realigning bones to correct deformities, especially in the lower limbs, to improve alignment, function, and gait.
• Spinal Fusion – For those with scoliosis or kyphosis, spinal fusion may be necessary. This procedure stabilises and straightens the spine by joining two or more vertebrae.
• Orthotic Devices – While not a surgical procedure, custom braces or orthotic devices may be prescribed to support weak limbs, improve gait, or prevent deformities.
• Shunt Procedures – Though primarily neurosurgical, these are relevant as they help treat hydrocephalus, a common complication in children with spina bifida. A shunt system diverts excess cerebrospinal fluid from the brain to another part of the body.
• Hip Surgeries – Some children may develop hip dislocations or subluxations. Procedures can range from soft tissue surgeries to realign the hip to more extensive procedures such as hip osteotomies.
• Foot and Ankle Procedures – Due to muscle imbalances, children might develop foot deformities like clubfoot, equinus, or valgus deformities. Surgeries can involve tendon transfers, lengthenings, or bony realignments.

Each child’s needs are unique, so the specific procedures recommended will be based on their individual challenges, goals, and overall health.

How does surgery help children with spina bifida?

Surgery plays a pivotal role in helping children with spina bifida address various complications associated with the condition. Shortly after birth, surgical intervention is often used to close the defect in the back, reducing the risk of infections and further injury to the exposed spinal tissue. For many children with spina bifida, hydrocephalus is a concern. Surgical placement of a shunt can divert excess cerebrospinal fluid from the brain to another part of the body, preventing potential brain damage. Orthopaedic surgeries can correct or alleviate musculoskeletal problems. For instance, tendon lengthening can improve joint mobility and function, while bone realignments can correct limb and spine deformities. Some children may need surgeries to address hip dislocations or foot deformities, enhancing their mobility and potential to walk. Additionally, surgeries can also aid in managing bladder and bowel dysfunctions.

When is spine surgery necessary for children with spina bifida?

Decisions about spine surgery are made based on the individual needs of the child, the progression of the deformity, and the potential benefits versus risks. Regular assessments by paediatric and orthopaedic staff help determine the optimal timing and approach for such interventions.

Surgeons can undertake an operation to correct and secure the spine in children diagnosed with scoliosis. This might involve removing certain vertebrae or joining two or more vertebrae permanently through a process known as spinal fusion. To maintain the spine’s position and prevent the curve from reappearing during growth, surgeons might incorporate metal screws or plates.

The surgery is conducted under general anaesthesia in a hospital setting. It’s advised that children stay in the hospital for a few days post-surgery for monitoring. Specialists in pain management should be consulted to guarantee the child’s comfort.

What are the risks with spine surgery for children with scoliosis?

Spine surgery for children with scoliosis is generally safe but carries potential risks. There’s a chance of infection at the surgical site or deeper within the body. Significant blood loss can occur during or after the procedure. The metal hardware used, like screws and rods, might cause pain, or in rare cases, shift from their intended positions, requiring further surgeries. There’s also the risk of the spinal fusion not healing properly, known as pseudarthrosis, which may necessitate additional interventions. In very rare circumstances, surgical error can lead to spinal injuries.

What should I do if my child has suffered an injury during surgery?

Whilst seeking corrective surgery, care and support for your child will be your priority, there may be some very rare scenarios where you suspect a healthcare provider to be at fault for things that have gone wrong during surgery. If your child has sustained an injury during surgery, and you believe the surgeon or hospital is at fault for it, you may have the grounds to bring a medical negligence claim. If this scenario applies to you, call us on 1800 390 555 and an experienced member of staff will discuss your situation and potential next steps. You can also email [email protected] and we will get back to you as soon as we can.