Treatment and Diagnosis
How We Treat Congenital Spine Disorders
Surgical treatment for congenital spine defects vary by type:
Spina bifida aperta (Myelomeningocele)
NewYork-Presbyterian has the only program in the city offering fetal intervention to repair myelomeningocele, a form of spina bifida associated with a wide range of complications including early death, paralysis, and bowel and bladder dysfunction. Performing this surgery while the baby is still in the womb has been shown to significantly improve results by decreasing the need for cerebrospinal fluid shunting and improving motor function.
In other instances, myelomeningocele is repaired in the first days of life. The surgeon protects the spinal cord from further damage, removes as many problematic elements as possible, restores as much normal structure as possible, then closes the membranes and skin over the spinal cord. This operation cannot reverse the damage that has already occurred. However, it prevents further damage and dramatically reduces the risk of infection.
While in utero repair of the fetus with myelomeningocele is preferable, there are several exclusionary criteria such as fetal age, spinal deformity, and level of the spinal defect as well as several maternal constraints including diabetes and certain uterine anatomical variants that may require a repair after the baby is born.
Spina bifida occulta
Does not need surgical repair if it causes no symptoms.
Decompression surgery involves removing the thin piece of bone or cartilage to relieve pressure on the spinal cord and brain and provide new pathways to drain cerebrospinal fluid.
Split cord malformation (Diastematomyelia)
Decompression surgery involves removing the thin piece of bone or cartilage that divides the spinal cord. Removing this piece provides more room for the spinal cord within the spinal column. In many cases, removing this piece also “un-tethers” the spinal cord, allowing it to move freely once again. Sometimes the dura, the sleeve around the spinal cord, is also repaired at the time of surgery.
Spinal cord lipoma (Lipomyelomeningocele)
Surgery is performed to free the spinal cord from its attachment to the lipoma, removing as much of the lipoma as safely possible, and closing the membranes over the spinal cord.
Dermal sinus tract
Surgery is performed to remove the tract, untether the spinal cord, and to prevent any loss (or any further loss) of neurological function. The tract must be removed because it provides a conduit from the spinal canal to the outside world which can lead to serious infection of the nervous system.
Tethered spinal cord
Surgery for tethered cord is tailored to the cause of the tether. In general, the spinal column is opened from behind via a laminectomy to reveal the location of the tether. The surgeon then works carefully to release the tethering.
Scoliosis, kyphosis, and lordosis
Pediatric neurosurgeons, spinal neurosurgeons and orthopedic surgeons collaborate to perform delicate microsurgery to correct the abnormal curvature.
The full extent of the problems associated with congenital spine disorders are usually not completely understood immediately at birth but may be revealed as the child grows and develops. Children with spine disorders require frequent examinations and diagnostic testing by their physician to monitor the development of the head and spine as the child grows. The medical team works closely with the child’s family to provide education and guidance to improve the health and well-being of the child.
Genetic counseling may be recommended by the physician to provide information on the recurrences of the congenital spine disorder and any available testing.
Our Approach to Care
At NewYork-Presbyterian, we take a fully integrated approach to the treatment of congenital spine disorders in children at every stage, from fetal to infancy, childhood, adolescence, and the transition into adulthood.
Holistic and Comprehensive Care
At NewYork-Presbyterian, we recognize that every patient with a congenital spine disorder has a unique combination of symptoms, circumstances, and needs. Our pediatric neurosurgeons take a holistic approach to care that considers the entire patient, including his or her physical, emotional, and social factors. We strive to partner with patients and their parents in shared decision-making, empowering them with knowledge, support, and the most effective treatment options to address symptoms and improve their quality of life.
Collaborative and Multidisciplinary Care for Children of all Ages
NewYork-Presbyterian offers the full range of therapies a newborn, young child, or adolescent with congenital spine disorders may require. Bringing together our pediatric surgical, medical, anesthesiology, and support specialists into one coordinated team helps us to provide the most effective care for your child. You can be assured that your family will be in the expert hands of a medical team renowned for excellence in pediatric neurology and neurosurgery and committed to a shared goal of providing your child with the safest, most advanced surgical techniques available.
Early Intervention to Maximize Outcomes
When a spinal defect in your baby is suspected during pregnancy, we bring together a team of high-risk obstetricians, neonatologists, pediatric neurologists, and pediatric neurosurgeons to precisely diagnose the spinal defect and develop a plan with you for the remainder of your pregnancy and delivery. For some patients, this may involve surgery. Working closely with our Maternal-Fetal-Medicine and Pediatric specialists, our pediatric neurosurgeons can provide care for your baby as early as possible. New techniques and advances even allow your baby to be treated in the prenatal stage, before birth.
Minimally Invasive Surgery
Whenever possible, we use minimal access surgery to ensure the best results and the fastest recovery possible. Across our state-of-the-art facilities, we employ the latest and least invasive devices and techniques for the best possible outcomes.
Continuity of Care throughout the Lifespan of the Child
There is a growing recognition that pediatric patients with chronic ailments need to receive continuous care by experienced and familiar surgeons as they age beyond their childhood years. At NewYork-Presbyterian, the pediatric neurosurgery team takes a multidisciplinary approach that focuses on the whole child and offers them the best opportunity to enjoy a normal transition from childhood to adulthood.
Children who have a lifelong need for specialized care, such as those with spina bifida, myelomeningocele, hydrocephalus, epilepsy, and craniofacial disorders, are embraced by our care teams. Our pediatric neurosurgeons understand the continuous needs of their patients regardless of age and are vested in making certain that the transition from childhood to adulthood is simplified by not needing to change care teams. Our teams work with children through their adolescence, teen years, and early adulthood to help them understand their responsibility for their health and achieve their personal goals at every stage.
When it is time, we help our patients seamlessly transition to one of our adult physicians in the NewYork-Presbyterian Neurology & Neurosurgery program.