In certain cases of myelomeningocele (the severe form of spina bifida), surgery can be performed while the baby is still in the womb. This is known as in utero fetal surgery (fetal repair). A landmark clinical trial called the MOMS Trial (Management of Myelomeningocele Study) demonstrated that prenatal surgery can significantly improve outcomes compared to postnatal repair (CDC, 2024b). In this procedure (typically done around 22–26 weeks of pregnancy), a skilled surgical team opens the mother’s uterus (either through a large incision or sometimes via smaller incisions with fetoscopic techniques) and surgically closes the baby’s spinal defect. By covering the exposed spinal cord sooner, this prevents ongoing damage to the nerves during the remainder of pregnancy. Prenatal surgery has been shown to reduce the risk of infant death, reduce the need for a shunt for hydrocephalus, and improve motor function at 30 months of age (CDC, 2024b). Children who had fetal repair are also more likely to walk independently than those who had surgery after birth (UCSF Benioff Children's Hospitals, n.d.). However, fetal surgery comes with risks to both mother and baby, including the possibility of preterm birth or maternal health complications. It’s only offered at specialized centers and if strict criteria are met. Fetal repair has now become an option for many families after a prenatal diagnosis – the care team will discuss if the baby is a good candidate. It represents a shift in spina bifida management: treating the condition before birth to limit damage rather than only after birth.

Whether or not fetal surgery was done, nearly all babies with open spina bifida will undergo surgery (postnatal repair). If fetal repair wasn’t performed, a neurosurgeon typically operates shortly after birth (usually within 24–48 hours) to close the opening in the back (UCSF Benioff Children's Hospitals, n.d.). The surgeon places the spinal cord and nerves back inside the spinal canal, removes the exposed sac if present, and closes the surrounding tissue layers. This protects the spinal cord and helps prevent infection. While this surgery doesn’t fix nerve damage that occurred in utero, it safeguards the baby’s health and starts the treatment process. Babies generally recover over a week or two in the neonatal intensive care unit. 

Many children with myelomeningocele develop hydrocephalus (excess fluid on the brain), which is managed with a ventriculoperitoneal (VP) shunt. This flexible tube is inserted into the brain’s ventricles and drains fluid to the abdominal cavity (UCSF Benioff Children's Hospitals, n.d.). In some cases, endoscopic third ventriculostomy (ETV) may be used instead. Shunt systems often require long-term monitoring and occasional revision. Nonetheless, they are effective in preventing cognitive damage from hydrocephalus and are a standard part of care.

Children with spina bifida often need orthopedic support and physical therapy, beginning in infancy. Assistive devices like braces, walkers, or wheelchairs are commonly used. Orthopedic surgeons may treat clubfoot or scoliosis with casting, bracing, or surgery. Tethered cord syndrome, where scar tissue restricts the spinal cord’s movement, may also require surgery. Therapy and orthopedic care aim to improve mobility and independence throughout childhood and adolescence.

Most individuals with myelomeningocele have neurogenic bladder and bowel issues. Clean intermittent catheterization is typically started in infancy to drain the bladder regularly (UCSF Benioff Children's Hospitals, n.d.). Medications or surgery may be used to manage bladder pressure or incontinence. Bowel programs involve scheduled toileting, diet changes, and sometimes surgery for better control. With consistent care, many children achieve good continence and avoid infections.

Additional therapies may include speech therapy, educational accommodations, skin care to prevent pressure sores, and planning for transition to adult care. Attention to latex allergy, mental health, and social development are also part of long-term care. As patients age, topics like independence, sexuality, and employment support become important.