Spina Bifida (“Open Back”): Surgical Therapy

1st order

  • Spina bifida aperta: here, the cele (blister-like protrusion; hernial sac) is first incised (sparing the nervous tissue). The spinal cord is gently transferred back into the spinal canal. The spinal canal is closed with a fascial flap. Wound closure is performed in layers or by means of plastic coverage.
  • Myelomeningocele: here, the closure must be done immediately after birth due to the increased risk of infection of the spinal cord.
  • Hydrocephalus (hydrocephalus): here, a “shunt” must be created to relieve the pressure, that is, a catheter is inserted to drain the cerebrospinal fluid (brain fluid) into the abdomen (abdominal cavity).

In the case of co-existing micturition disorders (bladder emptying disorders; neurogenic bladder), the following surgical measures can be considered:

  • In cases of uncontrollable detrusor hypertrophy (trabeculation and pseudodiverticulum formation of the bladder):
    • Denervation (separation of the detrusor from the associated nerve tracts) of the bladder.
    • Bladder augmentation (bladder enlargement).
    • Rhizotomy – surgical transection of a nerve root.
  • For unmanageable sphincter externus spasticity:
    • Incision (cutting into) the sphincter externus.
    • Stent implantation (small, lattice-shaped support that serves to dilate) to widen the sphincter externus (external sphincter)
    • Injection of botulinus toxin into the sphincter.

The required surgical procedures should be completed before enrollment.