Spina bifida (SB) remains a major cause of lifelong disability worldwide. Although historically associated with high morbidity, outcomes have improved substantially due to:

  • Primary prevention through folic acid fortification

  • Early neurosurgical intervention, including fetal surgery

  • Innovations in urologic reconstruction that address secondary complications

The information below synthesizes evidence demonstrating how these targeted interventions reduce SB incidence, enhance function, and improve quality of life. By integrating findings from population health, clinical trials, and surgical outcomes research, we illustrate how coordinated, evidence-based approaches reshape health trajectories for individuals with SB.

On This Page:

Background

This narrative review draws from:

  • Population level studies on the impact of mandatory folic acid fortification
  • Findings from the Management of Myelomeningocele Study (MOMS) and subsequent fetal surgery trials
  • Contemporary surgical literature examining:
    • Clean intermittent catheterization (CIC)
    • Catheterizable channels (Mitrofanoff, MontiMalone)
    • Reconstructive approaches for neurogenic bladder and bowel dysfunction

The information highlights prevention, prenatal intervention, and reconstructive surgery across the SB lifespan, focusing on effectiveness, functional outcomes, and persistent gaps in access.

Key Findings

Folic Acid Fortification

  • Reduces neural tube defects by 30–50% in regions with mandated fortification
  • Associated with fewer severe SB presentations
  • Contributes to reductions in orthopedic interventions and lifetime healthcare costs
  • Opportunities for fortification mandates, including corn masa in California (into effect January 2026)

Fetal Surgery for Myelomeningocele

  • In utero repair improves motor function and reduces rates of hydrocephalus compared to postnatal repair
  • Shown to reverse or lessen hindbrain herniation (MOMS trial)
  • Risks include maternal morbidity and preterm delivery
  • Emerging fetoscopic approaches aim to minimize maternal risk while maintaining benefits

Urologic Reconstruction & Continence Tools

  • 50% of individuals with SB experience chronic incontinence
  • Procedures such as Mitrofanoff and MontiMalone channels:
  • Enable clean intermittent catheterization
  • Promote continence and independence
  • Reduce renal complications and preserve long term kidney function

Implications & Impact

These interventions collectively represent a paradigm shift in SB care:

  • Folic acid fortification: highly effective, scalable primary prevention
  • Fetal surgery: early neurological preservation that improves developmental trajectories
  • Catheterizable channels: enhance autonomy, reduce caregiver burden, and protect renal health
  • Global gaps persist, including lack of fortification policies, limited access to fetal surgery, and unequal availability of reconstructive services. Continued innovation and implementation are essential to achieving improved, lifelong outcomes worldwide.

Conclusion

Targeted prevention and surgical advances significantly improve health and quality of life for individuals with SB.

Multidisciplinary, lifespan-oriented care remains essential.
Future priorities include:

  • Expanded global fortification efforts
  • Refinement of minimally invasive fetal techniques
  • Regenerative medicine approaches (stem cells, tissue engineering)
  • Improved access to reconstructive urologic care

Acknowledgements

This project is supported by the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $400,000 with 100 percent funded by CDC/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CDC/HHS, or the U.S. Government. 

Source

American Academy of Pediatrics