Spina Bifida Best Treated BEFORE Birth, Study Suggests

(CBS/AP) What's the best time to treat babies with spina bifida? Before they're born.

That's right. Prenatal surgery to fix the hole in the spine that causes the potentially crippling condition leads to better outcomes, according to a landmark study funded by the government. The operation showed such a clear benefit over waiting until the infant is born that the study was stopped early.

"This is the first hope for spina bifida fetuses," said lead researcher Dr. Scott Adzick of Children's Hospital of Philadelphia, one of three places that participated in the study.

The government-funded study showed that babies who have the operation in the womb were more likely to walk without help and less likely to need a tube to drain fluid buildup in the brain. Fetal surgery did come with some risks, however, including a higher chance of premature birth and complications for the mother.

Spina bifida - which means split spine - happens when the spine doesn't develop properly. In the most severe cases, the spinal cord sticks out through an opening in the spine. Children often are paralyzed or have weakness below the waist. Many need crutches or a wheelchair. They also suffer from incontinence and fluid buildup in the brain.

Doctors started experimenting with fetal surgery for spina bifida in the mid-1990s, cutting into the mother's abdomen and uterus to close the gap in the spine. It even became part of the abortion debate when a photo of a tiny hand poking out of a womb during surgery was published.

Cases in the U.S. have fallen to 1,500 a year since 1998, when the government ordered that foods like cereals, breads and pasta be fortified with folic acid, which reduces the risk of the spinal defect.

Though spina bifida is usually diagnosed before birth, the operation is typically done days after delivery. Quick surgery can prevent further harm but cannot reverse the nerve damage that has already occurred.

When fetal surgery for spina bifida was first tried, it was controversial because operations in the womb were typically done for life-threatening problems. There was also no long-term research on the safety of the surgery. The operation even got caught up in the abortion debate when abortion opponents seized on a photo taken during surgery on a 21-week-old fetus at Vanderbilt University.

Since fetal surgery is highly specialized, some experts said that the results may not be as good in hospitals with little experience and that more work is needed to better determine who will benefit most.

"Caution is necessary here," Dr. Joe Simpson of Florida International University and Dr. Michael Greene of Massachusetts General Hospital wrote in an editorial.

Seven years after fetal surgery, Evan Terrell of Nashville, Tennessee, is more active than his parents ever hoped. He swims, rides his bike and plays basketball with his friends. Soon after birth, Evan went through intensive physical therapy to strengthen his legs. He needed braces and inserts in his shoes to help him walk as a toddler, but no longer requires any assistance.

His mother, Kristie Terrell, who participated in the study at Vanderbilt and stayed in the hospital for a month, said she is thankful that he didn't need a shunt in his brain.

"He is a bouncing, hyper, beautiful boy," she said.