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Conditions We Treat: Spina Bifida
Spina bifida is a birth defect caused by incomplete formation of the spine. Nerves from the spinal cord can protrude through the opening in the spine and are exposed to the outside. This is called a myelomeningocele (MMC), and it is the most serious form of spina bifida. The abnormal position of the spinal cord also pulls the lower portion of the brain downward into the spinal canal (Chiari 2 malformation). The Chiari 2 malformation blocks the normal outflow of fluid that is produced within the brain (cerebrospinal fluid or CSF), leading to swelling of the ventricles where the CSF is produced. This is called hydrocephalus.
During fetal life, MMC can interfere with several aspects of development. Damage of the nerves can lead to paralysis of the legs, abnormal foot position, and abnormal bowel and bladder function. Hydrocephaly and the Chiari 2 malformation can lead to developmental delays and difficulties with breathing and blood pressure control. Due to the multiple care needs a child with spina bifida can have, a dedicated multidisciplinary clinic such as the Philip A. Keelty Center for Spina Bifida and Related Conditions at the Kennedy Krieger Institute provides the best management approach.
When the MMC is repaired before birth by fetal surgery, infants are less likely to require shunt treatment for hydrocephalus and have improved nerve function and development compared with infants who receive standard surgery after birth. The Johns Hopkins Center for Fetal Therapy offers fetal MMC repair for patients meeting specific inclusion criteria.
Spina Bifida: Why Choose Johns Hopkins
- We understand the urgency involved developing a care path for fetuses with a diagnosis of spina bifida. The Center for Fetal Therapy is available to take your call at any time and will see you as soon as possible.
- We are one of the most experienced centers in the United States at performing fetoscopic repair of myelomeningocele (MMC) and treating spina bifida.
- Fetal endoscopic surgery, or fetoscopy, is a surgical technique used by our fetal therapy specialists that is far less invasive for a mother’s uterus compared with open surgery.
- After treatment for spina bifida, our patients will have continued access to the most advanced care specialties from Johns Hopkins Children’s Center, including advanced brain imaging, pediatric neurosurgery, neonatal-perinatal medicine and developmental follow-up as needed once your child is born. We all work as a team to create a care plan that works best for mother, child and family.
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Diagnosing Spina Bifida
Before birth, spina bifida can be suspected by obstetric ultrasounds in the first and second trimester. Indicators from the ultrasound include a change in the head shape or fluid-filled spaces in the brain. Also, an increase in the mother’s blood levels of alpha-fetoprotein can also be an indicator of spina bifida. Once the diagnosis has been made, a detailed fetal ultrasound and amniocentesis are typically performed to determine the severity of birth defects or genetic conditions. Magnetic resonance imaging (MRI) is used in combination with the prenatal ultrasound to accurately define the extent and severity of spina bifida.