Best Doctors in India for Spina Bifida Treatment

Profile Highlights:

  1. Dr. A Navaladi Shankar is a well-known spine surgeon and orthopedist in Chennai with 21+ years of experience.
  2. He completed an MBBS from Al-Ameen Medical College, MNAMS from the National Board of Education, and a Diploma from Sri Ramachandra Medical College and Research Institute.
  3. Dr. Shankar holds expertise in Laminectomy, Lower Back Pain and Neck Pain Treatment, Arthritis Management, and Trauma Surgery.

Profile Highlights:

  • Dr. Abhaya Kumar is a leading name in the field of Neurosurgery who is an expert in Minimally Invasive Spine Surgery, Brain surgery, and Stereotactic Radiosurgery and has performed more than 1400 spine surgeries and 1100 brain surgeries in KDAH alone.
  • Dr. Abhaya Kumar’s primary focus includes Minimally Invasive Spine Surgery (MISS) and has handled over 800 MISS cases till date in the hospital with 96% successful results.

Profile Highlights:

  • Dr. Amit Kumar Agarwal is a Delhi-based orthopedic, joint replacement, and spine surgeon consultant who has been assuring joint and spine health for about 18 years.
  • Dr. Agarwal has garnered numerous accolades for his work in treating Joints and Musculoskeletal Disorders, pain management, sports injury, and articular degeneration during his career.

Profile Highlights:

  • Dr. Anil Kumar Kansal is a well-known neuro and spine surgeon in Delhi with over 2 decades of experience.
  • He has performed over 10,000 neurosurgical procedures including 4500 brain surgeries, 500 endoscopic brain surgeries, 2000 spine surgeries, 400 aneurysms, and 500 anterior cervical microdiscectomies with 60 disc replacement procedures.
  • Dr. Kansal holds great skills in aneurysm clippings, neuro-modulation, epilepsy, and neurovascular surgery and has handled several such types of cases in his career.

Profile Highlights:

  • Dr. Arun Saroha is a renowned Neurosurgeon with extensive experience in the surgical treatment of all kinds of brain and spine disorders.
  • He holds an experience of over 20 years in the field and has performed over 8000 neurosurgeries till date for different types of neuro and spinal diseases.
  • Dr. Saroha is an expert in minimally invasive spine surgery, neuro-onco surgery, trauma surgery and is also among the few neurosurgeons with expertise in Pediatric neurosurgery.

Profile Highlights:

  • Dr. Ashok Hande is a renowned neurosurgeon in Mumbai who holds the credit for 300 AVMs, 1400 skull base tumor surgeries, 3600 surgeries for cranial and spinal trauma, 1200 lumbar prolapsed intervertebral disc surgeries, 800 cerebral aneurysms, and more than 100 microvascular decompressions.
  • He holds an experience encompassing 25+ years and holds the credit for pioneering neurosurgery in Mumbai by bringing in new and advanced neurosurgical procedures for brain and spine surgery.

Profile Highlights:

  • Dr. Bipin Walia is one of the most famous neurosurgeons who has performed over 7000 successful neurosurgeries so far.
  • He earned his MBBS and MS (General Surgery) degree from Armed Forces Medical College, Pune, followed by which his, M.Ch(Neurosurgery) from All India Institute of Medical Sciences, New Delhi.
  • Dr. Bipin Walia has over 20 years of experience with his outstanding performance earning him quite some rewards and recognition.

Profile Highlights:

  • Dr. Deepu Banerji is a leading name in the field of Neurosurgery in India and possesses extensive skills in minimally invasive and micro neurosurgery.
  • He has been practicing neurosurgery for over 28 years and is counted among the best microscopic neurosurgeons in the country.
  • Apart from minimally invasive surgeries, his expertise lies in skull base surgery, brain tumors surgery, vascular surgery, and spine surgeries, and has handled numerous cases of brain and spine diseases and disorders.

Profile Highlights:

  • Dr. Gautam Zaveri is one of the best spine surgeons in India today and has performed over 3000 spinal surgeries for the treatment of spinal fractures, trauma, slipped discs, kyphosis, scoliosis, sciatica, spondylolisthesis, and spinal stenosis.
  • Dr. Zaveri specializes in Minimally Invasive Spine Surgeries commonly known as MISS and performs most of his procedures using this technique to minimize cuts and speed up the recovery process.

Best Hospitals in India for Spina Bifida Treatment

Indraprastha Apollo Hospital, New Delhi

Hospital Highlights:

  • Indraprastha Apollo Hospital is a 700-bedded multispecialty hospital in the heart of the capital of India. It is a part of Apollo Hospital group, one of India’s most reputed healthcare chains. Indraprastha Apollo Hospital has been accredited by Joint Commission International, making it the first internationally accredited hospital in the country in 2005.
  • There are 52 specialties in the hospital with one of the best cardiology centers in the country. The hospital is also equipped with State of the art infrastructure facilities with the largest Sleep Lab in Asia and the largest number of ICU bed facilities in India.
  • The hospital also has one of the largest dialysis units in India along with a dedicated Bone Marrow Transplant unit.
  • The latest and highly advanced technologies that are installed in the hospital include Da Vinci Robotic Surgery System, PET-MR, PET-CT, Cobalt-based HDR Brachytherapy, Brain Lab Navigation System, Tilting MRI, Portable CT scanner, 3 Tesla MRI, 128 Slice CT scanner, DSA Lab, Endosonography, Hyperbaric Chamber and Fibro scan.

Fortis Memorial Research Institute, Gurugram

Hospital Highlights:

  • Fortis Memorial Research Institute is a multi-super-specialty, quaternary care hospital with 1000 beds. The hospital comprises reputed clinicians, and international faculty and is also equipped with cutting-edge technology. The hospital is a part of Fortis Healthcare Limited, a reputed chain of private hospitals in India.
  • It is a NABH-accredited hospital that is spread across 11 acres of land and has a capacity of 1000 beds. The hospital has 55 specialties and is one of the premier health care centers in the Asia Pacific region popularly known as “the Mecca of Healthcare”.
  • The hospital has 260 diagnostic centers and is also equipped with the latest and advanced techniques that include 3 Telsa which is the world’s first Digital MRI technology. The hospital also has world-class Radiation Therapy techniques which have been developed by leading technology experts from Elekta and Brain Lab.

Apollo Hospital, Chennai

Hospital Highlights:

  • Apollo Hospitals, Chennai, is one of the best hospitals for heart care in India. Over the years, Apollo has expanded all over India, as a healthcare chain.
  • India’s first ‘Only Pancreas’ transplant was performed in Apollo Hospital. The hospital is known for successfully performing Asia’s first en-bloc combined heart and liver transplant, and over the years, it has attained a remarkable achievement in the global healthcare space. Around 3-4 organ transplants are performed in the hospital per day.
  • Equipped with over 500 beds, this hospital in Chennai was established in 1983 and since then has been among the most preferred hospital for patients from all over the world.
  • The hospital holds accreditation of the NABH and JCI and is the first hospital in India to be ISO 9001 and ISO 14001 certified. It is also the first South Indian Hospital to receive subsequent reaccreditation from the JCI USA 4 times.

Medanta-The Medicity, Gurgaon

Hospital Highlights:

  • One of India’s best and largest multi-specialty hospitals, Medanta was built with the aim to bring India to the highest standards of medical care. The hospital has been providing the best medical services to its patients, since its inception, with care, commitment, and compassion.
  • Equipped with 1250 beds, the hospital was founded by Dr. Naresh Trehan in the year 2009 with an aim to provide the best medical care at affordable costs. The hospital is spread across 43 acres and includes 45 operation theatres and 350 beds dedicated solely to ICU. The hospital includes over 800 doctors, and more than 22 specialty departments and has a dedicated floor for individual specialty in order to offer the best services under one roof.
  • The hospital is considered one of the premier institutes in India for Cardiac Care and includes staffs and members of high caliber. The hospital has 6 distinct centers of excellence.

Max Super Specialty Hospital, New Delhi

Hospital Highlights:

  • One of the well-regarded providers in India committed to the highest standards of clinical excellence and patient care, Max Super Specialty Hospital is a part of Max Healthcare, which is the second-largest healthcare chain in India. Regarded as one of the most well-regarded healthcare providers in the country, Max Super Specialty Hospital is committed to the highest standards of clinical excellence as well as patient care. The hospital is also equipped with the latest technology as well as cutting-edge research. The hospital is known to deliver and ensure the highest level of patient care.
  • The hospital has more than 500 beds and offers treatment for over 35 specialties. The hospital also holds the credit of having installed the first Brain Suite in Asia. This is a highly advanced Neurosurgical machine that allows MRI to be taken while surgery is ongoing.
  • Other advanced and latest technologies are also installed in the hospital such as the 1.5 Tesla MRI machine, 64 Slice CT Angiography, 4D ECHO, LINAC, and 3.5T MRI machine.

Artemis Hospital, Gurugram

Hospital Highlights:

  • One of the most well-known hospitals in the Delhi NCR, Artemis Hospital is the first hospital in Gurugram to get accredited by the Joint Commission International.
  • With more than 40 specialties, the hospital has been designed to be one of the most technically advanced hospitals in the country, with the best medical and surgical health care. The hospital has eleven special and dedicated centers, for Heart, Cancer, Neurosciences, etc.
  • The latest technologies in the hospital include Endovascular Hybrid Operating Suite and Flat panel Cath Labs for the cardiovascular department, 3 Tesla MRI, 16 slice PET CT, 64 Slice Cardiac CT Scan, HDR Brachytherapy, and highly advanced Image Guided Radiation Therapy techniques (LINAC) are installed in the hospital.
  • The hospital has won several awards as well, since its inception.

BLK Max Super Specialty Hospital, New Delhi

Hospital Highlights:

  • Equipped with 650 beds, BLK Superspecialty Hospital is the largest stand-alone private sector hospital in Delhi.
  • With over 1500 healthcare providers and 150 globally renowned super specialists, the hospital is one of Asia’s largest Bone Marrow Transplant Centres. The hospital is known for having some of the best cancer doctors in the country.
  • The hospital is NABH and NABL accredited and was inaugurated by the first Prime Minister of India. Pt. Jawahar Lal Nehru.

Gleneagles Global Hospitals, Chennai

Hospital Highlights:

  • Established in 1999, Gleneagles Global Hospital, Chennai, is one of the top healthcare facilities in Southern India. It is part of the Gleneagles Hospital Chain, which is the fourth largest healthcare chain in the country. The hospital specializes in multi-organ transplants of kidneys, liver, lungs, heart, etc.
  • The hospital has an excellent infrastructure and state-of-the-art lab and equipment set-up. The hospital boasts cutting-edge technologies, a highly skilled team of doctors and surgeons, and trained support staff. Located in Perumbakam, Chennai, it is one of India’s premier health care destinations. The hospital has performed some of the most complex surgical and clinical procedures in India including multi-organ transplantations.
  • The hospital’s lung transplantation program is one of the best in the country. The hospital is known for having performed India’s first single lung transplant and first minimal invasive lung transplant. It is also the only Indian hospital to be associated with King’s College Hospital, London, United Kingdom for liver transplantations.

Fortis Hospital, Mulund, Mumbai

Hospital Highlights:

  • Fortis Hospital in Mulund is a 315-bed multi-speciality tertiary care hospital with five JCI accreditations that offers a wide variety of diagnostic and therapeutic services. The Fortis Hospital in Mulund delivers patient-centred treatment with cutting-edge technology, highly skilled and experienced surgeons, and paramedical staff.
  • This institution houses Maharashtra’s largest multi-organ transplant centre. It is also the first heart transplant centre in western India to conduct 100 or more consecutive heart transplants in under four years. It is the only hospital in the city to have multi-organ transplants and has handled the youngest patient for angioplasty. Fortis Hospital Mulund now boasts the first advanced surgical robot in central Mumbai.
  • Cardiology and heart surgery, urology, nephrology, neurosciences, orthopaedics, digestive care, emergency and critical care, and maternity care are among the services provided by the hospital.

Kokilaben Dhirubhai Ambani Hospital, Mumbai

Hospital Highlights:

  • Kokilaben Dhirubhai Ambani Hospital, Named after the wife of Indian industrialist Dhirubhai Ambani, the founder of Reliance Industries, this is one of the top hospitals in Mumbai. This 750-bed multi-specialty hospital became operational in 2009. Known as one of India’s most advanced tertiary care facilities, the hospital is designed to raise India’s global standing as a healthcare hub, with an emphasis on excellence in clinical services.
  • Kokilaben Dhirubhai Ambani Hospital uses Protocol and Care Pathway based treatment models to ensure the best outcomes for patients.
  • The hospital represents a confluence of top-notch talent, cutting-edge technology, state-of-the-art infrastructure, and, most importantly commitment.
  • The hospital also holds the accreditation of the NABH, NABL, CAP, and JCI.
  • The hospital has been recognized as the No. 1 Multispecialty Hospital in Mumbai and the West Zone for the fifth year in a row in 2020 by The Week.

Spina Bifida

Spina Bifida also known as neural tube defect, is a birth defect that occurs when your spine and spinal cord don’t form correctly. The neural tube is the structure in a developing embryo which eventually becomes the brain of the child, spinal cord as well as the tissues enclosing them.

In normal cases, the neural tube forms early during pregnancy and it closes by the 28th day after conception. In babies with spina bifida, one portion of the neural tube fails to close or develop properly, which results in defects in the spinal cord and the spinal bones.

Spine Bifida can be mild as well as severe, as it depends on the type of defect, location, size as well as complications. When required, early treatment for spina bifida will involve surgery, but the problem isn’t always resolved by such treatment.

Types of Spina Bifida

There are three main types of spina bifida, which include myelomeningocele, meningocele and spina bifida occulta.

1.Myelomeningocele- The most common and serious type of spina bifida which involves a sack outside the opening in the back of the baby somewhere in the spine, which contains parts of the spinal cord as well as nerves which will get damaged. People who have myelomeningocele can have physical disabilities which may be moderate to severe and some of such disabilities can include:

  • Incontinence
  • Difficulty in going to the washroom
  • Inability in moving or feeling one’s legs or feet

 

2.Meningocele- Meningocele is another type of spina bifida which involves a sack of fluid outside an opening in the back of the baby. However, the sack doesn’t contain any part of the spinal cord, as there isn’t much nerve damage, this kind of spina bifida only leads to minor problems.

3.Spina Bifida Occulta- This is another mild type of spina bifida which also goes by the term ‘hidden spina bifida’, as it doesn’t cause any disabilities and might go unnoticed until later in life. Usually, there is no opening the in back of the baby but only a gap in the spine. In this type, there is also damage to the spinal cord or the nerves.

Symptoms of Spina Bifida

Each type of spina bifida shows different symptoms and they can vary from person to person as well.

Symptoms of myelomeningocele spina bifida can include:

  • Over some of the vertebrae the spinal canal is open, often in the middle or lower part of the back
  • Weak or paralyzed muscles in the leg
  • Membranes and spinal cord pushed outside the back in a skin-covered sack
  • Deformed feet
  • Uneven hips
  • Seizures
  • Scoliosis
  • Issues with the bowel and bladder

 

Symptoms of meningocele can include the following:

  • Sack that is visible at birth
  • Small opening at the back
  • Membranes which are pushing out through the opening in the vertebrae into the sack
  • Normal spinal cord development
    Spina bifida occulta symptoms include-
  • No visible opening outside
  • A gap in between vertebrae
  • No fluid-filled sack outside the body
  • Small cluster of hair on the back
  • A small area of extra fat on the back
  • Small birthmark such as a dimple on the back

Causes of Spina Bifida

All the exact causes of this ailment are still not understood properly. However, it is known that combination of genetics and environmental factors are involved. A child who is born with spina bifida might not have any relatives with this condition but genetics does play a factor. It is also believed that lack of folic acid (vitamin B-9) can play a role in this ailment. Other factors that are said to play a role include obesity, some kind of medications and uncontrolled diabetes in the mother.

Diagnosis of Spina Bifida

Pregnant women will be offered prenatal screening tests for checking for spina bifida and other birth defects. These tests aren’t perfect. Some mothers had positive blood tests have babies without spina bifida. Even if the result is negative, there is a slight chance that the spina bifida is present, so consider talking to your doctor regarding prenatal testing, its risks and you now need to handle the results.

Though spina bifida can be screened using maternal blood tests, typically ultrasound is used for diagnosis in most cases.

Maternal Serum Alpha-Fetoprotein test

For Maternal Serum Alpha-Fetoprotein test, a sample of the mother’s blood is drawn to be tested for alpha-fetoprotein, a protein that is produced by the baby. It’s quite normal for a little amount of AFP to cross the placenta and enter the mother’s bloodstream, but abnormally high levels of AFP suggests that the baby has a neural tube defect, which can be spina bifida, even though high levels of AFP don’t occur always in spina bifida.

Test to Confirm high AFP levels

Varying levels of AFP can also be caused by other factors, which include a miscalculation in the fetal age of multiple babies. Therefore, your doctor might order another blood test for confirmation, If the results are still high, you will need even further evaluation, which will include an ultrasound exam.

Other blood tests

Your doctor can perform the MSAFP test along with few other blood tests. Commonly done with the MSAFP test, their objective is to screen for other abnormalities like trisomy 21, not neural tube defects.

Ultrasound

Fetal ultrasound is the most accurate method for diagnosing spina bifida in the baby before delivery. Ultrasound may be performed during the first trimester and second trimester. Spina bifida can be diagnosed accurately in the second-trimester ultrasound scan. This exam, therefore, becomes quite important to identify and rule out congenital anomalies like spina bifida.

An advanced ultrasound can also detect signs of spina bifida, which includes an open spine or particular features in the brain of the baby, which indicate spina bifida. An expert can easily assess the severity of the ailment using ultrasound.

Amniocentesis

If the prenatal ultrasound confirms the diagnosis of spina bifida, your doctor might request amniocentesis. During this process, your doctor removes a sample of fluid from the amniotic sac surrounding the baby using a needle. The purpose of this examination is to rule out genetic diseases, even though spina bifida is rarely associated with genetic diseases.

Treatment options for Spina Bifida

The treatment for spina bifida may vary as it always depends on the severity of the condition. While spina bifida occulta won’t require any treatment, other types do.

Surgery before birth

Nerve function in babies who have spina bifida can get worse after birth, if spina bifida isn’t treated. Prenatal surgery to treat spina bifida takes place before the 26th week of pregnancy. In this procedure, surgeons expose the uterus in the pregnant mother surgically open the uterus and repair the baby’s spinal cord. In some patients, this procedure can be performed even less invasively with a fetoscope through ports in the uterus.

According to research, children with spina bifida who goes through fetal surgery have reduced disability and are less likely to require crutches or any such walking devices. Fetal surgery can reduce the risk of hydrocephalus as well. Consult with your doctor whether this procedure is appropriate for you. Talk regarding the potential benefits and risks such as possible premature delivery as well as other such complications.

It is also quite important to have a comprehensive evaluation to determine whether fetal surgery is feasible. This specialized surgery should only be done at a proper health-care facility that has experienced doctors in fetal surgery. A multispeciality team approach and neonatal intensive care are also important. The team typically includes a fetal surgeon, a pediatric neurosurgeon, a maternal-fetal medicine specialist, a fetal cardiologist as well as a neonatologist.

Cesarean birth

Most babies who have myelomeningocele are usually in a feet-first position. If your baby is in this position or the doctor has detected a large crys or sac then cesarean birth might be the safer way to deliver your baby.

Surgery after birth

Surgery is required for babies with myelomeningocele, and the earlier it is performed, the earlier the risk of infections will be minimized. It will also help in protecting the spinal cord from being exposed to further trauma.

During this procedure, the neurosurgeon will place the spinal cord along with the exposed tissue inside the baby’s body, after which he will cover them with muscle and skin. At the same time, the neurosurgeon might place a shunt in the baby’s brain for controlling hydrocephalus.

Treatment for complications

For babies having myelomeningocele, there has been already irreparable nerve damage and usually a multispeciality team of surgeons, physicians and therapists might be required. Babies having this ailment might need even more surgery to treat a variety of complications. Some of these complications might include weak legs, bladder and bowel problems or hydrocephalus, which usually begins soon after birth.

Depending on the severity of spina bifida and the complications, the treatment options can include:

  • Walking and mobility aid- Some babies can start exercises to prepare their legs for walking with the aid of braces of crutches as they get older. Some children might need walkers or wheelchairs. Mobility aids combined with regular physical therapy can help a child in becoming independent. Even children who require wheelchairs can learn to function quite well and become self-sufficient.

 

  • Bowel and bladder management- Routine evaluation of bowel and bladder evaluations as well as management plans can help in the reduction of the risk of organ damage and illness. Evaluations can include X-rays, kidney scans, blood tests, ultrasounds and bladder function studies. These evaluations will have to be done frequently in the first few years of life but it can become lesser, as the child continues to grow.

 

  • Surgery for hydrocephalus- Most babies who have myelomeningocele, will require a surgically placed tube which can allow fluid in the brain to drain into the abdomen. This tube might be placed just after the baby is born, during the surgery to close the sac located on the lower back or later as the fluid accumulates. A less invasive option is also available which is called endoscopic third ventriculostomy. However, candidates are chosen very carefully for this and they need to meet certain criteria. During this procedure, the surgeon will use a small video camera to see inside the brain. He makes a hole in the bottom of between the ventricles so cerebrospinal fluid may flow out of the brain.

 

  • Treatment and Management of other complications- Special equipment which includes bath chairs, commode chairs as well as standing frames might help with daily activities. Whatever the issue, orthopedic complications or tethered spinal cord, most of them can be treated or managed to help improve the child’s quality of life.

Prevention of Spina Bifida

Taking folic acid in supplement form at least one month before one’s conception and continuing through the first trimester of the pregnancy can greatly reduce the risk of spina bifida and other neural tube defects. Having plenty of folic acid in the system by the early weeks of pregnancy is important if you want to prevent spina bifida. Since many women don’t realize that they are pregnant till this time, it is recommended by experts that women who are of childbearing age, should take at least a daily supplement of 400 micrograms of folic acid. Food such as rice, pasta, enriched bread and some breakfast cereals are rich in folic acid.

Women who are planning or expecting pregnancy should also remember to consume at least 400 to 800 mcg of folic acid per day. The human body doesn’t absorb folate as easily as it can absorb synthetic folic acid and therefore it is important that you take vitamin supplements as well. It is also quite possible that folic acid will help to reduce the risk of other birth defects, including cleft lip, cleft palate as well as some congenital heart defects.

It is quite a good idea to eat a healthy diet, including foods that are rich in folate or enriched with folic acid. It is seen to be present naturally in several foods, such as egg yolks, milk, beans, peas, citrus fruits, juices, avocados, dark green vegetables, etc.

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