NHS to Offer Spina Bifida Surgery In Utero

A partnership between Great Ormond Street Hospital (GOSH) and University College London Hospitals (UCLH) has succeeded in carrying out a UK-first by operating on the spinal cords of babies still in the womb.

The first two operations, which each took around ninety minutes to complete, involved surgeons from GOSH and UCLH repairing holes in the spines of the two babies with spina bifida, which is a neural tube defect that causes a gap in the spine. The surgery improves outcomes and prospects even before a baby has been born; children born with spina bifida may experience serious developmental challenges learning to walk and often require multiple surgeries, including “shunts”, which are designed to drain fluid from the brain.

It is the first time that the fetal surgery has been performed in the UK. Previously, the surgery has had to be performed abroad or postnatally in the UK. However, by learning from a Belgian team headed by Professor Deprest as well as from a mentorship with the Children’s Hospital of Philadelphia, the UK partnership has broken new domestic ground and is now ideally placed to help the around 200 babies a year born in the UK with spina bifida.

“In spina bifida, the spinal canal does not close completely, leaving the spinal cord exposed from an early stage in pregnancy. This results in changes to the brain, as well as severe trauma-related injuries to the nerves on the lower half of the body,” lead neurosurgeon Dominic Thompson told press.

“Closure in the womb is an alternative to postnatal surgery, and improves short and medium-term outcomes. While neither intervention is fully curative, in fetal surgery, the defect is closed earlier which prevents damage to the spinal cord in the last third of pregnancy.”

The surgery involves placing the mother under anaesthetic and then making an incision similar to that made during a Caesarean section. The baby’s exposed spinal cord is then placed correctly into the spinal canal and encased in a protective layer of skin and muscle in order to prevent the leakage of spinal fluid.

A Case Study

It was during her 20-week scan that Bethan Simpson, a 26 woman from Maldon, Essex, was told that her unborn daughter Eloise had spina bifida. Doctors then advised her to terminate the pregnancy.

However, after becoming the fourth recipient of the operation in the UK when she was at 24 weeks, she is now expecting her baby in April; the same month which the operation is set to become available on the NHS.

“It is not a cure. But there is quite clear evidence through critical trials that the outlook can be a lot better with surgery early on,” commented one of the surgeons.

For information on how to help prevent spina bifida, read Dr Jonathan Pearson-Stuttard’s article on the importance of taking folic acid supplementation during pregnancy.