Shine news

Patients will now be able to have 'life-changing' spina bifida surgery in the womb on the NHS

26th September 2019


Article from Mail Online

To read the full article click here

  • The open surgery can repair defects on the spinal cord to avoid nerve damage
  • It is already used in the US and has been trialled experimentally in the UK
  • Around four babies a week are born with spina bifida and some could be helped 

NHS doctors will be able to perform open spine surgery on unborn babies with spina bifida 'within weeks', the health service has announced.

The surgery involves taking the foetus out of the womb temporarily for an operation to repair its spinal cord to prevent nerve damage.

It has already been used experimentally and is performed elsewhere in the world but has now been approved for routine use by NHS doctors.

Around four babies are born each week with spina bifida and the condition can cause lifelong disabilities such as leg paralysis, incontinence and numbness. 

The organisation which tells the NHS which drugs and procedures it can use, the National Institute for Health and Care Excellence (NICE), has approved the surgery.

The procedure, called open repair for an open neural tube defect, is already used in the US and can reduce how much damage the spine sustains in the womb.

Foetuses which develop with an open neural tube defect have a part of their spinal column which doesn't close properly.

This exposes vital nerves which can be damaged by physical contact.

Damaging the nerves in the spine can have catastrophic consequences, including paralysis and loss of control of organs include the bladder and bowel.

Open repair involves making a caesarean section-type incision on the mother's belly, pulling out the baby, surgically repairing the spine, then putting the baby back in and letting the pregnancy continue.

'These innovative procedures have the potential to reduce the symptoms that would otherwise result from spina bifida, improving the quality of life for those with the condition,' said NICE's Professor Kevin Harris.

'However, these are technically challenging procedures and should only be done in specialised centres, by clinicians and teams with specific training and experience in fetal surgery and who analyse the outcomes to both the foetus and mother.'

The NHS's medical director, Professor Stephen Powis, added: 'The NHS will be offering open spinal surgery for spina bifida for unborn babies to eligible women in just a few weeks.'

In its conditions for sanctioning the surgery, NICE said it must only be done my specialist surgeons trained specifically how to do it.

Hospitals must also review and audit the outcomes and recovery of every single patient who receives the surgery, and make sure parents are well-informed.

Gill Yaz, a spokesperson for the spina bifida charity, Shine, told MailOnline the operation could be used to help around 20 babies per year.

She said: 'We welcome this and we're really pleased that we've got this in this country and parents don't have to travel for the surgery.

'Until about 18 months ago people had to get EU funding and travel to other countires like Belgium or Switzerland, and we know families were doing that.

'It's used widely in the US and has proved safe, effective and beneficial in most cases and we've been building on that approach and refining it to make it more effective.

'Every option that's available to parents is a good thing.'

However, Ms Yaz emphasised that the surgery is not a cure, and the best thing women can do to protect their babies from spina bifida is take folic acid before they get pregnant.

She added: 'Taking folic acid before you're pregnant will prevent a certain number of spina bifida cases and taking a cheap vitamin is preferable to major surgery halfway through your pregnancy.

'From our point of view primary prevention is more important.'

The surgery will have strict criteria about who can and can't have it, and it must usually be carried out before the baby is 26 weeks old.

It can't be done on twins or women who have placentas in positions which make it difficult, Ms Yaz said.

NICE also considered whether it should approve a second type of operation, in which the spine is repaired through keyhole surgery.

This one was turned down, however, on the grounds that not enough research has been done to prove it is effective and safe.

To see a video about Spina Bifida and information about the surgery click here.

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