Myelomeningocele (Open Spina Bifida)

What is this condition?

Myelomeningocele is open spina bifida in which meninges and neural tissue protrude through the spinal opening. Nerves below and within the lesion may be malformed or damaged before birth, so early closure protects tissue and reduces infection but cannot restore normal function already absent. Hydrocephalus and Chiari II malformation are common associated conditions.

What symptoms can it cause?

• Open moist sac or neural placode on the back
• Leg weakness/paralysis and altered sensation below lesion
• Foot, hip or spinal deformity
• Neurogenic bladder/bowel and signs of hydrocephalus

How is it assessed and diagnosed?

Prenatal ultrasound and fetal MRI may define the lesion and brain findings. At birth, the baby needs neurological, head, skin and associated-anomaly assessment. Brain/spine imaging, renal ultrasound and later urodynamics guide treatment. Latex sensitivity risk is recognised in long-term care.

Treatment without surgery

Immediately after birth, the lesion is covered with a sterile non-adherent moist dressing, pressure is avoided, temperature and fluids are supported, and neonatal/neurosurgical transfer is arranged. Bladder emptying and infection prevention follow specialist protocols. Families need compassionate counselling without unrealistic promises or hopeless language.

When is surgery or a procedure considered?

Postnatal closure is usually performed early when the infant is stable. Prenatal fetal repair is available only in highly specialised programmes for carefully selected pregnancies and has maternal and fetal risks; it reduces some complications but is not a cure. Hydrocephalus may require a shunt or selected endoscopic treatment.

Treatment and procedure options

• Early postnatal neural-tube closure
• Prenatal repair in a specialised selected programme
• Shunt or endoscopic CSF treatment
• Later untethering for progressive tethered-cord symptoms
• Urology, orthopaedics, rehabilitation and skin care throughout life

Risks from the disease and from treatment

Risks include meningitis, hydrocephalus, Chiari symptoms, kidney damage, pressure sores, fractures, deformity and tethering. Closure can be complicated by CSF leak, infection, wound breakdown or neurological change. Function relates strongly to lesion level but remains individual. No procedure is risk-free. General risks include anaesthetic problems, bleeding, infection, blood clots and delayed healing. Neurological risks depend strongly on the exact structure being treated and may include new weakness, numbness, speech or vision change, seizure, cerebrospinal-fluid leakage, need for another procedure or failure to obtain the hoped-for relief. The surgeon should discuss the risks that apply to the individual case.

Recovery and follow-up

Care focuses on maximising health and independence: kidney-safe bladder management, bowel programme, mobility, orthoses, skin inspection, nutrition, school inclusion and psychosocial support. Shunt and tethered-cord warning signs must remain familiar during growth. Recovery is not judged only by the first few days. Pain control, wound care, nutrition, safe mobilisation, physiotherapy and planned follow-up all matter. Some symptoms improve quickly after pressure is relieved; others recover gradually over weeks or months, and permanent nerve injury may not fully reverse.

Preparing for your consultation

Bring the original MRI/CT images or digital files, written reports, previous prescriptions, a current medicine list, and any operative or pathology records. For sudden warning symptoms, use the nearest emergency department rather than waiting for a routine appointment.

Authoritative patient-information sources

• CDC — Spina Bifida: https://www.cdc.gov/spina-bifida/about/index.html
• AANS — Spina Bifida: https://www.aans.org/patients/conditions-treatments/spina-bifida/