What if surgeons could repair a birth defect before a baby is even born?
For some families facing a diagnosis of spina bifida, that possibility is now real thanks to advances in fetal surgery.
Spina bifida is a condition that develops early in pregnancy when a baby’s spine does not fully close, leaving part of the spinal cord exposed.
“With spina bifida, every baby comes to us in a different place,” says Martha Monson, MD, a maternal-fetal medicine specialist at University of Utah Health. “This is a chronic, lifelong condition with varying degrees of severity.”
Because the spinal cord is exposed to amniotic fluid during pregnancy, inflammation can damage the nerves over time—leading to lifelong challenges.
What Challenges Can Spina Bifida Cause?
Symptoms vary widely. Some children have mild symptoms, while others have more complex needs.
Babies born with spina bifida may experience:
- Weakness or paralysis in the legs
- Difficulty walking
- Bladder or bowel problems
- Hydrocephalus, build-up of fluid in the brain
Repairing the Spine Before Birth
For many years, the only option was to repair the spinal defect after birth. Today, advances in prenatal surgery allow doctors to repair the spine while the baby is still in the womb. One of the newest techniques is called fetoscopic spina bifida repair.
“Using a camera and specialized instruments, we repair the baby’s spine through small openings in the uterus, closing the spinal cord in three protective layers,” says Stephen Fenton, MD, a pediatric surgeon at University of Utah Health and Intermountain Health Primary Children’s Hospital.
Repairing the spine earlier in development helps protect the spinal cord from further damage during pregnancy.
Research shows prenatal repair may help:
- Lower the risk of hydrocephalus
- Reduce the need for shunt placement (a device that drains fluid from the brain)
- Improve movement and motor function
“This repair decreases the chance of needing shunts,” Fenton says. “This is really important because that has long-term implications. It can also improve function by one or two spinal levels, which can make a big difference between walking with or without assistance versus not walking at all for these kids and their families.”
Why the Fetoscopic Approach Matters
Early fetal surgery required a large opening in the uterus. While effective, that approach increased risks during pregnancy and future pregnancies.
The fetoscopic technique uses much smaller uterine incisions.
This approach may help:
- Reduce surgical stress on the uterus
- Lower complications during pregnancy
- Preserve the uterus for future pregnancies
“The goal is to have the same benefits for the baby but with less risk and fewer long-term consequences for the mother,” Monson says.
By minimizing the uterine opening, surgeons can repair the spinal defect while reducing risk for the pregnant parent.
A Highly Coordinated Team
Operating on an unborn baby requires an experienced and highly coordinated team.
“This surgery truly takes a village,” Fenton says. “There are usually 20 to 30 specialists in the room—surgeons, maternal-fetal medicine physicians, anesthesiologists, cardiologists, and nurses—all focused on caring for both mom and baby.”
At the Grant Scott Bonham Fetal Center at Intermountain Health Primary Children’s Hospital, specialists like Fenton closely monitor both patients. A fetal cardiologist watches the baby’s heart while surgeons repair the spinal defect.
Behind the scenes, nurses and surgical teams coordinate every step to ensure the safest possible outcome.
Improving the Future for Children with Spina Bifida
Although fetal surgery does not cure spina bifida, it can help improve mobility and independence for many children as they grow.
“It can significantly improve outcomes,” Fenton says. “It can reduce the chance a child will need a brain shunt and improve motor function.”
Many babies who undergo fetal repair continue to receive care through specialized spina bifida clinics where doctors monitor their development and provide ongoing support.
For the physicians performing these procedures, the impact reaches far beyond a single surgery.
“What we’re doing here has the potential to impact generations,” Fenton says. “Helping one child can change the course of an entire family’s future.”
As fetal medicine continues to advance, procedures like fetoscopic spina bifida repair offer new hope to families—and new possibilities for children before they are even born.
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