Getting pregnant is a true blessing for all couples. However, if you get to know your child is born with a spinal deformity, it will be devastating, right? Neural tube defects (NTD) are congenital disabilities affecting the brain and spinal cord of the child. In India alone, over 1 lakh babies are born with NTDs yearly. Spina bifida is the most common type of NTD that can be avoided by taking a few measures.
Spina bifida, a spinal birth defect, is treated by neurosurgeons. You must consult the best pediatric neurosurgeon for a successful surgery. The surgeons in countries like India, Turkey, UAE, and Germany are highly skilled and have been internationally trained for various fetal conditions, including spina bifida. These countries offer low-cost treatment plans without compromising the quality of care.
In India, the cost of spina bifida surgery revolves around INR 3,00,000.
This blog is a complete guide on spina bifida, its causes, treatment, prevention, and costs in various countries.
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What is Spina Bifida?
Spina bifida is an inborn disease that develops within 3-4 weeks of pregnancy. It is a condition in which the neural tube does not close all the way. The spine and spinal cord are not fully formed and have open lesions, causing severe nerve damage.
The condition affects 1500-2000 children each year in the US. The severity of the damage caused by spina bifida depends on:
- Location and size of the opening
- Type of defect and parts of the spine involved
- Which nerves come out of the opening
Not everyone with spina bifida will experience complications. Those affected by the severe forms are likely to suffer from problems like:
- Orthopedic complications
- Bowel and bladder problems
- Hydrocephalus
- Walking and mobility problems
- Scoliosis (curved spine)
- Infections
- Chiari malformation
What are the Types of Spina Bifida?
Spina bifida or split spine is of 3 main types.
- Spina Bifida Occulta: Known as the "hidden" spina bifida, it is the mildest and the most common form of spina bifida. Involving a minimal portion of the spine, the condition does not show any prominent signs & symptoms. Spina bifida occulta affects around 10 to 20% of the US population, and most people don't even know they have it. The disorder rarely causes problems and does not require any treatment.
- Meningocele: In this rare form of spina bifida, the bones do not fully form around the spinal cord. A fluid-filled sac is formed as the meninges (membranes covering the spinal cord) are pushed out through the orifice. Since the spinal cord is not in this sac, there is little to no nerve damage.
- Myelomeningocele: It is the most aggressive type of spina bifida in which a bag of fluid containing parts of the spinal column and nerves comes through an opening in the back. It accounts for approximately 75% of all spina bifida cases. The disorder causes moderate to severe disabilities like paralysis, bladder & bowel dysfunction, and loss of feelings in the legs.
What are the Causes and Risk Factors of Spina Bifida?
Doctors are still trying to find the exact causes of spina bifida. However, it is thought that a mixture of environmental, nutritional, and genetic factors causes the condition.
Females, white people, and Hispanics are more likely to develop spina bifida. Several other risk factors associated with spina bifida are:
- Folate Deficiency: Vitamin B9 or folate deficiency is one of the prime causes of neural tube defects, including spina bifida.
- Family History: Couples with a child affected by NTD are at a higher risk of having another one with the same defect. Also, women born with an NTD have increased chances of giving birth to a child with spina bifida.
- Medications: Some medicines, like anti-seizure (valproic acid), when taken during pregnancy, can cause NTD.
- Medical Conditions: Women with uncontrolled diabetes are more likely to give birth to a baby with spina bifida. The chances of NTDs also increase with pre-pregnancy obesity.
- Hyperthermia: Some evidence suggests an increased body temperature in the early weeks of pregnancy may slightly increase the chances of spina bifida.
Is Spina Bifida Diagnosable During Pregnancy?
Yes, with the help of prenatal screening tests, spina bifida can be diagnosed during pregnancy. But these tests are not 100% accurate. Even with negative test results, there are minor chances of spina bifida being present.
- Blood Tests: Tests like the maternal serum alpha-fetoprotein (MSAFP) test help diagnose spina bifida. The test helps check the alpha-fetoprotein (AFP) amount in the blood. Women carrying a child with spina bifida have 75 to 80% higher amounts of AFP in the blood.
- Ultrasound: It is the most accurate way of diagnosing spina bifida. Fetal ultrasound during the second trimester is crucial for identifying congenital abnormalities like spina bifida. Advanced ultrasound (sonogram) helps assess the severity of the disease.
- Amniocentesis: When prenatal ultrasound confirms the presence of spina bifida, the doctor may suggest an amniocentesis. The test is done by taking the fluid from the amniotic sac using a needle. There are slight chances of miscarriage with amniocentesis; your doctor will discuss these before the test.
Can you Prevent Spina Bifida Before or During Pregnancy?
Even though the exact reasons for spina bifida are not well established, you can still avoid the disorder by following simple measures like:
- Taking 400 micrograms (mcg) of folic acid or folate daily during childbearing years reduces the chances of spina bifida by 75%. If the mother or her child has spina bifida, she should start taking 4000 mcg of folic acid (vitamin B9) at least a month before getting pregnant. Folic acid, present in egg yolks and green vegetables, significantly reduces the odds of having a child with spina bifida.
- It is necessary to tell the doctor if you are taking any medicines, including herbal supplements, to avoid spina bifida.
- Maintaining optimal body temperature is also necessary to prevent neural tube defects.
- Avoid using saunas and hot tubs that increase the body temperature.
- If you are suffering from diabetes or obesity, it is crucial that you manage these conditions properly during your pregnancy.
What is the Treatment Plan for Spina Bifida?
The treatment of spina bifida depends on the type of disease and its severity. Not all spina bifida require treatment. The one which does are treated in the following ways:
- Surgery Before Birth: Prenatal or fetal surgery for spina bifida is done before the 25th week of pregnancy. The surgeon inserts the fetoscope into the pregnant mother's uterus and repairs the baby's spinal cord. Prenatal surgeries reduce disabilities and the risk of hydrocephalus.
- Surgery After Birth: Myelomeningocele requires surgery within 72 hours after the birth. During the surgery, the neurosurgeon puts the spinal cord and the exposed tissues back into the infant's body. In meningocele, the surgery is done within 24 to 48 hours of the birth. The surgery involves placing the membrane around the spinal cord back in its place.
- Treatment for Complications: Myelomeningocele can cause irreparable nerve damage. It requires ongoing care from different medical specialists, including surgeons, physicians, and therapists.
- Difficulty in walking is managed using crutches, wheelchairs, and braces.
- For bladder issues, catheters, and oral medication are used.
- Bowel complications are managed using suppositories and enemas.
- Ventricular shunts surgically manage hydrocephalus.
What is the Cost of Spina Bifida Treatment?
As mentioned earlier, spina bifida is managed in different ways. The treatment plan involves surgery to close the opening in the spine. Medicines and physical therapy are also required to treat related complications.
The cost of spina bifida surgery in India starts from INR 2,50,000 and goes up to INR 4,50,000. International patients can expect this cost to be in the range of USD 5,500 to USD 7,000.
The spina bifida surgery cost in Turkey is around USD 17,000. The price is similar in Thailand. The patient is admitted to the hospital for about 5 days and has to stay outside the hospital for 15 days for follow-ups.
Takeaway
Spina bifida is a congenital disorder affecting the spine. Everyone with the disease doesn't need to experience disability. The extent of damage ranges from mild to severe, depending on the type of disease. With the advances in medical technologies and spinal surgeries, most children with spina bifida can now lead full lives. Various excellent neurosurgery hospitals in India, Turkey, and Germany offer affordable treatment for neural tube defects, including spina bifida.
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