World pioneering foetal surgery against spina bifida successfully undergone in a Catalan hospital

Barcelona (ACN).- Vall d’Hebron Hospital, in Barcelona, successfully achieved a new intra-uterus surgery procedure against spina bifida, which stops the disorder worsening during pregnancy. The new surgery was carried out on a 24 week old foetus by opening the uterus and placing a biological fabric on the baby’s spinal cord. This new practice means a significant step forward as, until now, babies with spina bifida were treated once they were born, and the disorder worsens in the last weeks of pregnancy. When in contact with amniotic liquid, the spinal cord gradually deteriorates within the uterus and the illness worsens, causing lower extremity paralysis, permanent incontinence, and in the worst cases hydrocephaly and cerebellum hernia. The Vall d’Hebron medical team developed a more effective technique to place a piece of biological fabric on the spinal cord of the foetus, in order to protect it from amniotic liquid and to allow skin to develop and close the gap. Therefore, the spinal cord stops deteriorating and the child does not have to wait until birth to be treated. Some pioneering intra-uterus surgeries had already been carried out, but the Vall d’Hebron Research Institute has developed a new technique, which offers more guarantees to the patient as it is faster and therefore less aggressive. The first foetus that went through this technique is now a 5 month old baby girl named Esther, who was introduced to the press by her proud parents on Wednesday in Barcelona. Despite the fact that Esther’s spinal cord had already started to be affected by the amniotic liquid during the early stages of the pregnancy, she can easily move her feet and legs. Doctors are confident she will be able to walk normally. However, they have some doubts about her sphincter control.

What is spina bifida?

Spina bifida or myelomeningocele (in its most severe form) is a congenital disorder that affects one in every thousand babies in Spain. It consists of a disorder of the central nervous system, which causes paralysis of the lower extremities, with difficulty or inability to walk as well as sphincter incontinence once the baby is born. In addition, it might cause hydrocephalus and Chiari II malformation, which is an accumulation of cerebrospinal fluid in the brain combined with a cerebellum hernia.

The problem occurs because the spine does not close properly and the spinal cord is thus exposed, as well as all the nerves. Some vertebrae are not fully formed, and therefore remain open, leaving the spinal cord unprotected, normally at the lumbar or sacra area. In contact with the amniotic fluid within the uterus, there is a deterioration of the spinal cord. In addition, a portion of it may form a type of hernia, filled or not with a cerebrospinal liquid. All the nerves controlling the lower part of the body are therefore affected. In addition, the illness often affects the entire central nervous system, causing headaches, nausea, and fatigue.

A new technique

Up until now treatment for children with spina bifida was to operate once the baby was born, closing the spine’s open part. However this does not halt the deterioration of the spinal cord’s lesions during pregnancy. The surgery during pregnancy stops the injuries, so the baby is born with some degree of spina bifida but the deterioration will have been halted.

The Bioengineering, orthopaedics and surgery group of the Vall d’Hebron Research Institute (Vall d’Hebron Institut de Recerca) developed a new technique that reduces the manipulation of the foetus to only 45 minutes. The new technique is less aggressive than other pioneering intra-uterus practices against spina bifida. The group is now working on developing a technique enabling to practice the surgery without having to open the uterus.

Esther, the first baby

The first foetus to go through this technique was Esther, who currently is a five month old baby girl. Through a regular ecography, the spina bifida was detected in its early stages. Once the illness was confirmed with other tests, Esther’s parents decided to have the baby –as many parents decide to abort in a similar situation– and “take the risk” with the new technique, Esther’s father, Pavel Bota explains. The surgery took place when the foetus was 24 weeks old and Esther was born after 32.5 weeks of pregnancy. Mr. Bota thanked the medical team and said that his daughter is “in better shape everyday”. “She is a normal kid that brings joy to our home”, he added.