What is Myelomeningocele?

Myelomeningocele is a birth defect where the baby’s spinal cord, nerves, and fluid stick out through an opening in the back, forming a visible sac at birth. It is a severe form of spina bifida, a condition that occurs when the spinal bones (vertebrae) and spinal column do not close properly during early development in the womb.

Causes
The exact cause is not known. Normally, during early pregnancy, the spinal cord begins as an open tube and closes from top to bottom. Myelomeningocele happens when this closure process is incomplete, leaving part of the spinal cord exposed.

Risk Factors

A baby is more likely to develop myelomeningocele if:

• The mother did not get enough folic acid during pregnancy.

• There is a family history of spina bifida or neural tube defects.

• The mother takes certain medications, such as valproic acid, during pregnancy.
  
  

Signs and Symptoms

At birth, the baby has a fluid-filled sac on the back that contains nerves and part of the spinal cord.
Other symptoms depend on the level of the spinal defect and may include:

• Loss of bladder or bowel control (urine or stool leakage, or constipation).

• Lack of sensation below the sac.

• Weakness or paralysis in the legs, leading to delayed movement, crawling, or walking.

• Joint deformities in the hips, knees, or feet.

• Abnormal growth or curvature of the spine (scoliosis).

Diagnosis

Myelomeningocele can often be detected before birth through:

• Maternal blood tests (alpha-fetoprotein screening).

• Prenatal ultrasound, which can show the spinal defect.
  In some cases, it is diagnosed immediately after birth during a physical exam.
  
  

Treatment

While there is no cure, several treatments can help manage the complications. Treatment usually requires a multidisciplinary team including neurosurgeons, orthopedic surgeons, urologists, and physiotherapists.

Common treatments include:

• Surgery soon after birth to close the opening and prevent infection.

• Corrective surgery or braces for leg and foot deformities.

• Bladder management – medications, intermittent catheterization, or surgery to improve urine drainage.

• Bowel care – use of enemas, dietary changes, or medications to manage constipation or stool leakage.

• Ventriculoperitoneal (VP) shunt surgery to drain excess fluid from the brain (hydrocephalus) or treat Chiari malformation.

Your child will need long-term follow-up to monitor growth, kidney and bladder function, and mobility.

Home Care Tips

• Follow all instructions from your child’s care team for managing bladder, bowel, and orthopedic issues.

• Be cautious with hot water and heat sources, as areas with poor sensation may not feel burns.

• Check your child’s skin daily for redness, blisters, or sores.

• Give all prescribed medicines exactly as directed.

• Seek emotional and social support — family counseling or support groups can be very helpful.

• Keep all follow-up visits for kidney, bladder, and developmental checks.
  
  

When to Contact Your Doctor

Call your child’s healthcare provider if:

• There are new or worsening problems with urination or bowel movements.

• Your child develops new leg weakness, numbness, or headaches.

Get emergency help immediately if your child:

• Shows signs of increased pressure at the base of the brain, such as:

  • Labored or noisy breathing.

  • Choking or swallowing problems.

  • Hoarseness or weak voice.

  • Shallow or paused breathing.

• Has a VP shunt and develops headaches, seizures, or vision problems.

• Experiences a first-time seizure of any duration.

These may be signs of a serious or life-threatening problem that requires immediate medical care.

Summary

• Myelomeningocele is a type of spina bifida that occurs when the spinal column doesn’t close properly before birth.

• It causes a sac to form on the baby’s back containing nerves and spinal fluid.

• Early surgery and lifelong follow-up care can greatly improve your child’s health, comfort, and development.