Spina Bifida Repair
What is Spina Bifida Repair?
Spina bifida repair is a surgical procedure to correct a congenital neural tube defect where the spine and spinal cord do not form properly, leaving a gap in the vertebral column. This exposes the spinal cord and nerves, potentially leading to neurological complications. Surgery is often performed prenatally (fetal surgery) or shortly after birth to minimize risks. In India, spina bifida repair is conducted in pediatric neurosurgery departments at hospitals like Apollo, Fortis, Medanta, and AIIMS, offering advanced care at affordable costs. Understanding the procedure, costs, recovery, risks, and frequently asked questions (FAQs) is essential for parents in India to make informed decisions.
Why do you need Spina Bifida Repair?
Spina bifida repair is indicated for:
- Spina bifida aperta (open forms):
- Myelomeningocele: Most common, where the spinal cord and meninges protrude through the spinal defect in a sac, often at the lumbar or sacral level.
- Meningocele: Only the meninges protrude, with less severe neurological impact.
- Associated conditions:
- Hydrocephalus: Often present (80–90% of myelomeningocele cases), requiring a shunt to drain excess cerebrospinal fluid (CSF).
- Chiari II malformation: Downward displacement of the cerebellum, causing brainstem compression.
- Tethered cord syndrome: Spinal cord abnormally anchored, leading to neurological deficits.
- Goals:
- Prevent infection (e.g., meningitis) by closing the defect.
- Protect the spinal cord and nerves to minimize further damage.
- Reduce long-term complications like paralysis, bowel/bladder dysfunction, or hydrocephalus progression.
The procedure aims to close the spinal defect, preserve neurological function, and address associated complications, often requiring lifelong multidisciplinary care.
Why Do Spina Bifida Repair Costs Vary in India?
Costs range from ₹1 lakh to ₹5 lakh:
- Procedure Type: Postnatal repair (₹1–3 lakh); fetal surgery (₹3–5 lakh, rare in India).
- Hospital/Location: Higher in metro cities (Apollo, Fortis); lower in government hospitals (AIIMS, ₹30,000–₹1 lakh).
- Surgeon’s Expertise: Experienced pediatric neurosurgeons charge more.
- Additional Costs: Shunt placement (₹50,000–₹1 lakh), MRI/CT (₹5,000–₹15,000), ICU stay (₹10,000–₹50,000/day), maternal care (fetal surgery).
- Insurance: Covered for congenital defects; Ayushman Bharat offers subsidies.
Spina Bifida Repair Procedure
- Before Surgery Evaluation:
- Diagnosis:
- Prenatal: Ultrasound (16–20 weeks gestation) detects the defect; MRI confirms severity and associated anomalies (e.g., Chiari II, hydrocephalus).
- Postnatal: Physical exam (visible sac on the back); MRI/CT assesses spinal cord, brain, and hydrocephalus.
- Blood tests: Maternal alpha-fetoprotein (AFP) levels (prenatal screening); infection markers (postnatal).
- Timing: Surgery is ideally within 24–48 hours of birth (postnatal) to reduce infection risk; fetal surgery (if available) at 19–26 weeks gestation.
- Consent: Risks, including neurological deficits, are explained.
- Diagnosis:
- Surgical Techniques:
- Postnatal Repair:
- Performed under general anesthesia, lasting 2–4 hours.
- The newborn is positioned prone (face down).
- The defect is exposed; the sac (if present) is carefully opened, and the spinal cord/nerves are gently repositioned into the spinal canal.
- The meninges are closed over the spinal cord to prevent CSF leakage.
- Muscle, fascia, and skin are layered over the defect to create a watertight seal.
- Hydrocephalus Management:
- If present, a ventriculoperitoneal (VP) shunt may be placed (same surgery or staged) to drain excess CSF to the abdomen.
- Fetal Surgery (if available):
- Performed at 19–26 weeks gestation, lasting 3–5 hours.
- The mother undergoes general anesthesia; a uterine incision (similar to C-section) exposes the fetus.
- The defect is repaired similarly to postnatal surgery, closing the spinal layers.
- The uterus is closed; the pregnancy continues, with delivery typically via C-section at 37 weeks.
- Reduces hydrocephalus risk (40–50% need shunts vs. 80–90% in postnatal repair) and improves motor outcomes.
- Intraoperative Tools:
- Microscope: Enhances precision in handling delicate spinal tissues.
- Neuromonitoring: Tracks nerve function to avoid damage.
- Ultrasound (fetal): Guides fetal positioning.
- Postnatal Repair:
- After Surgery:
- ICU monitoring for 2–5 days to watch for infection, CSF leaks, or hydrocephalus.
- Hospital stay: 7–14 days (postnatal); longer for fetal surgery (mother and baby monitored).
- Pain management: Analgesics (e.g., paracetamol) for the infant; maternal pain control (fetal surgery).
- Antibiotics: For 3–5 days to prevent infection.
- Follow-up MRI/CT: At 1–3 months to assess closure, hydrocephalus, or Chiari II progression.
Recovery After Spina Bifida Repair
- Hospital Stay: 7–14 days (postnatal); 2–4 weeks for mother and baby (fetal surgery).
- Post-Surgery Care:
- Pain: Minimal in infants; maternal pain (fetal surgery) managed with analgesics.
- Positioning: Infants kept prone or on their side for 1–2 weeks to protect the repair site.
- Wound care: Keep incision dry; monitor for infection or CSF leak.
- Hydrocephalus monitoring: Signs (e.g., bulging fontanelle, irritability); shunt adjustments if placed.
- Neurological assessment: For leg movement, bladder/bowel function; deficits depend on defect level (higher defects cause more impairment).
- Multidisciplinary care: Physical therapy, urology (for bladder management), orthopedics (for leg deformities).
- Diet: Breastfeeding or formula (infants); normal diet for mothers (fetal surgery); 2–3 liters water daily.
- Follow-Up:
- Visits at 2 weeks, 1 month, and every 3–6 months; MRI/CT at 1–3 months.
- Shunt checks (if placed); monitor for tethered cord or Chiari II symptoms.
Recovery varies: Infants may show leg movement improvement (fetal surgery: 30–50% better motor outcomes); lifelong management for bladder/bowel, mobility, and hydrocephalus is often needed. Success rates for defect closure: 95–98%; infection prevention: 90–95%.
Risks and Complications
- Surgical Risks: Infection (3–5%, e.g., meningitis), CSF leak (5–10%), wound dehiscence (2–5%).
- Fetal Surgery-Specific:
- Preterm labor (20–30%): Risk of premature delivery.
- Uterine scar complications (5–10%): Impacts future pregnancies.
- Maternal risks (1–3%): Bleeding, infection, or pulmonary edema.
- Neurological Complications:
- Worsening deficits (2–5%): Due to nerve manipulation.
- Shunt complications (if placed, 10–20%): Blockage, infection, requiring revision.
- General Risks: Anesthesia reactions (infants/mothers).
- Long-Term:
- Tethered cord syndrome (20–30%): May require later surgery.
- Chiari II symptoms (10–20%): Breathing/swallowing issues.
- Mobility issues: 60–80% need braces/wheelchairs (depends on defect level).
Report fever, irritability, CSF leak (clear fluid from incision), or breathing difficulties promptly.
Frequently Asked Questions (FAQs)
What causes spina bifida?
Failure of the neural tube to close (4th week of pregnancy); risk factors: folate deficiency, genetics, diabetes, or certain medications (e.g., valproate).
Can spina bifida be treated without surgery?
No, open forms (myelomeningocele, meningocele) require surgery to prevent infection and further damage; spina bifida occulta (closed) may not need surgery.
Will my child walk after surgery?
Depends on defect level: Fetal surgery improves outcomes (30–50% walk with aids); postnatal repair: 50–70% need mobility aids (e.g., braces, wheelchair).
How soon must surgery be done?
Postnatal: Within 24–48 hours of birth; fetal: 19–26 weeks gestation (if available).
Is spina bifida repair covered by insurance in India?
Yes, for congenital defects; confirm with your provider.
Signs of complications?
Fever, CSF leak, irritability, poor feeding, or breathing/swallowing issues.
Can spina bifida be prevented?
Folic acid (400–800 mcg daily) before and during early pregnancy reduces risk by 50–70%; genetic counseling for high-risk families.
Lifestyle changes post-surgery?
Lifelong multidisciplinary care: Physical therapy, urology for bladder management, regular shunt checks, and monitoring for tethered cord/Chiari symptoms.
Conclusion
Spina bifida repair, whether postnatal or fetal, is crucial to prevent infection and minimize neurological damage, though lifelong care is often needed. India’s top hospitals (Apollo, Fortis, AIIMS) offer affordable, expert care. Understanding the procedure, costs, recovery, risks, and FAQs helps parents approach surgery confidently. Consult a pediatric neurosurgeon for personalized guidance and optimal outcomes.
Looking for Best Hospitals for Spina bifida repair
Note: we are not promoting any hospitals
we are not promoting any hospitals we sourced all the details from google and hospitals website, please verify and start with your surgery here we go the list includes government, budget and superspeciality hospitals accreditation bodies are the National Accreditation Board for Hospitals and Healthcare Providers (NABH) and the Joint Commission International (JCI)
- click on your city and schedule your surgery now done in good hands.
| City | Minimum Price (₹) | Maximum Price (₹) |
|---|---|---|
Agra |
2,50,000 |
6,00,000 |
Ahmedabad |
3,00,000 |
6,50,000 |
Ajmer |
2,50,000 |
6,00,000 |
Aligarh |
2,50,000 |
6,00,000 |
Allahabad |
2,50,000 |
6,00,000 |
Amritsar |
2,75,000 |
6,25,000 |
Aurangabad |
2,75,000 |
6,25,000 |
Bangalore |
3,00,000 |
6,50,000 |
Bareilly |
2,50,000 |
6,00,000 |
Belgaum |
2,75,000 |
6,25,000 |
Bhopal |
2,75,000 |
6,25,000 |
Bhubaneswar |
2,75,000 |
6,25,000 |
Bikaner |
2,50,000 |
6,00,000 |
Chandigarh |
3,00,000 |
6,50,000 |
Chennai |
3,00,000 |
6,50,000 |
Coimbatore |
3,00,000 |
6,50,000 |
Dehradun |
2,75,000 |
6,25,000 |
Delhi |
3,00,000 |
6,50,000 |
Dhanbad |
2,50,000 |
6,00,000 |
Durgapur |
2,50,000 |
6,00,000 |
Faridabad |
3,00,000 |
6,50,000 |
Ghaziabad |
3,00,000 |
6,50,000 |
Gorakhpur |
2,50,000 |
6,00,000 |
Guntur |
2,75,000 |
6,25,000 |
Gurgaon |
3,00,000 |
6,50,000 |
Guwahati |
2,75,000 |
6,25,000 |
Gwalior |
2,50,000 |
6,00,000 |
Hyderabad |
3,00,000 |
6,50,000 |
Indore |
2,75,000 |
6,25,000 |
Jabalpur |
2,50,000 |
6,00,000 |
Jaipur |
3,00,000 |
6,50,000 |
Jalandhar |
2,75,000 |
6,25,000 |
Jamshedpur |
2,75,000 |
6,25,000 |
Jodhpur |
2,50,000 |
6,00,000 |
Kanpur |
2,50,000 |
6,00,000 |
Kochi |
3,00,000 |
6,50,000 |
Kolkata |
3,00,000 |
6,50,000 |
Kollam |
2,75,000 |
6,25,000 |
Lucknow |
2,75,000 |
6,25,000 |
Ludhiana |
3,00,000 |
6,50,000 |
Madurai |
2,75,000 |
6,25,000 |
Mangalore |
2,75,000 |
6,25,000 |
Meerut |
2,50,000 |
6,00,000 |
Moradabad |
2,50,000 |
6,00,000 |
Mumbai |
3,00,000 |
6,50,000 |
Mysore |
3,00,000 |
6,50,000 |
Nagpur |
2,75,000 |
6,25,000 |
Nashik |
2,75,000 |
6,25,000 |
Navi Mumbai |
3,00,000 |
6,50,000 |
Noida |
3,00,000 |
6,50,000 |
Patna |
2,50,000 |
6,00,000 |
Pune |
3,00,000 |
6,50,000 |
Raipur |
2,75,000 |
6,25,000 |
Rajkot |
2,75,000 |
6,25,000 |
Ranchi |
2,50,000 |
6,00,000 |
Surat |
3,00,000 |
6,50,000 |
Thane |
3,00,000 |
6,50,000 |
Vadodara |
2,75,000 |
6,25,000 |
Varanasi |
2,50,000 |
6,00,000 |
Visakhapatnam |
2,75,000 |
6,25,000 |
Disclaimer
This information is sourced from open platforms and is for general awareness only. Costs may vary based on individual cases. Please consult a qualified doctor for medical advice and explore options within your budget before deciding on the procedure.