Pr. Haroon Choudhri Sheds Some Light on Spina Bifida
This article concerns patients with Spina Bifida explained through the following Q&A between Ms. Lynda Louifi, an Algerian journalist, and Pr. Haroon Choudhri Professor & Chief, Section of Adult Neurosurgery Spine, Director, Neurosurgery Spine, Service Department of Neurological Surgery Medical College of Georgia.
LL: Among all congenital malformations, Spina Bifida is certainly the most fearsome. What are the causes of Spina Bifida?
Can we prevent this abnormality?
Pr. HC: Spina Bifida and Myelomeningocele are neural tube defects (like anencephaly) and are associated with folic acid deficiency during early pregnancy. Prevention is best achieved by folic acid supplementation.
LL: What are the clinical manifestations of this malformation?
Pr. HC: Spina Bifida can be as simple as a small, insignificant bone development anomaly which is only noticed on x-rays (Spina Bifida Occulta) and can range to a very devastating developmental anomaly. Most commonly, there is a myelomeningocele or bubble over the lumbar spine with exposed neural tissue.
LL: If early surgical intervention is performed, can motor functions be saved?
Pr. HC: Possibly. Early surgery is critical to prevent life threatening infections associated with rupture of the membranes. Untethering of the spinal cord and repair of the myelomeningocele can prevent delayed development and neurologic injury
LL: The disease is widespread enough in our country. However, a prescription of the acid folique, before and during pregnancy, will suffice to prevent it.
What can you tell us about it?
Pr. HC: The problem is that neural tube defects take place very early in pregnancy, even before the woman knows she is pregnant. Even responsible women who see an their OB immediately after learning of pregnancy and start taking prenatal vitamins are still too late to prevent this in many cases.
This is why supplementation of the bread is used in many developed countries and we recommend that women of child bearing age should take folic acid daily just in case they become pregnant.
LL: When is the appropriate time to intervene on the fetus in order to avoid a malformation after birth?
Pr. HC: As with most medical problems, prevention is far more effective and less expensive than treatment. The children suffering with this need our help, however, from a public health standpoint, limited resources should be devoted to prevention programs
LL: Does fetal intervention in utero present risks?
Pr. HC: This is a very risky surgery and should only be undertaken by experienced Neurosurgeons. Although good outcomes with reduced scarring and less shunt dependence are possible, the extreme cost associated with this means that this represents the last and latest treatment for this problem.
First line treatment is prevention. Second line treatment is good quality Neurosurgical care for the patients who are born with these anomalies. Only when prevention efforts are maximized and most children have access to good quality Neurosurgical treatment can we ask "if we could spend even larger sums to treat this disease to get very limited additional benefits, what should we try...." Although I think that in utero surgery has real advantages, it is not a practical health expenditure. Wwhen so many more patients can be helped with far less expensive and simpler programs.
LL: Does fetal surgery have other applications?
Pr. HC: There are no other clear indications that I am aware of, however, this is an active area of research.
LL: What can you tell to parents of children with Spina Bifida?
Pr. HC: They cannot lose hope and need to try to seek the best care they can find. Once treated, these children can live very full lives and I feel it is worth fighting for them.
These parents should also know that they are at risk to have additional children with Spina Bifida and should use folic acid supplementation if pregnancy is remotely desired.
Haroon F. Choudhri, M.D.
Professor & Chief, Section of Adult Neurosurgery
Director, Neurosurgery Spine Service
Department of Neurological Surgery
Medical College of Georgia