Spina Bifida Surgery: Split Cord & Tethered Cord Release

In short

What Is Spina Bifida Surgery?

Spina bifida surgery is spine surgery that protects the nerves that still work. Specifically, it closes an open defect or frees a spinal cord that is stuck or split. So, the right operation depends on the type of spina bifida.

Spina bifida starts in the first weeks of pregnancy, when the spinal column fails to close around the cord. Therefore, open forms need closure within days of birth. In contrast, closed forms often need surgery later.

However, surgery cannot bring back nerve function that has already gone. Instead, it stops further harm, so timing matters as much as technique.

Illustration of open spina bifida: a sac on the lower back of a baby in the womb — Open spina bifida in the womb: the sac on the lower back holds spinal fluid and nerves.

Start with your situation

Where Are You in Your Decision?

First, pick the situation closest to yours. Then, each line opens the part of this page that answers it.

01Our baby has open spina bifidaClosure after birth or, in selected pregnancies, in the womb
02A scan showed a split spinal cordDiastematomyelia: type I and type II surgery
03My child may have a tethered cordSkin marks, foot changes, bladder or walking problems
04New problems after an earlier repairRetethering during growth
05I am an adult with spina bifidaTethered cord, shunt and Chiari problems in adults
06We are comparing risks, recovery and costResults, hospital stay and cost factors

Surgical options

Open and Closed Spina Bifida: Which Operation?

Open forms leave nerves exposed at birth, so they need early closure. In contrast, closed forms sit under normal skin and mainly cause trouble by tethering the cord.

Open spina bifida (myelomeningocele)

In myelomeningocele, the spinal cord and nerves lie open in a sac on the back. Therefore, surgeons usually close it within 48 hours of birth to lower the risk of infection.

Also, for selected pregnancies, specialist fetal teams repair the defect before 26 weeks. For example, in the MOMS trial, fetal repair roughly halved shunt use. However, it also raised the risk of early birth.

Afterward, many babies also need a shunt or an ETV for hydrocephalus. Our myelomeningocele guide also compares both repairs in detail.

Closed forms: lipoma and dermal sinus

A lipomyelomeningocele is a fatty lump that passes through a gap in the spine. Inside, the fat joins the lower end of the spinal cord. Surgery then removes as much fat as is safe, frees the cord and rebuilds its covering.

In addition, a dermal sinus is a tiny skin opening that can reach the cord. So, surgeons remove it soon after diagnosis, before germs reach the spinal fluid.

Questions at this stage

Does spina bifida occulta need surgery?

Usually not. In fact, most people with it never know they have it. Surgery only helps when a scan shows a hidden problem, such as a tight filum or a split cord.

What is spina bifida shunt surgery?

It is an operation for hydrocephalus, which often comes with open spina bifida. Specifically, a thin tube drains extra fluid from the brain into the belly. Usually, the tube stays for life.

Is surgery right for you?

When Is Surgery the Right Step?

Not every form of spina bifida needs an operation. However, some findings call for surgery, and a few need urgent care.

Surgeons usually recommend surgery for:

An open defect on the back at birth
A type I split cord, often even before symptoms
A tethered cord with new or worsening symptoms
A dermal sinus tract over the spine
A spinal lipoma with signs of tethering

Seek urgent care for:

Fast new weakness in one or both legs
Sudden loss of bladder or bowel control
Fever with redness or fluid from a back wound or skin opening
Clear fluid leaking from a recent wound
Headache, vomiting and sleepiness in a child with a shunt

Generally, a spine MRI and an examination settle the question. Also, for other signs in children, see our pediatric neurosurgery guide.

Compare

Types of Spina Bifida and the Surgery Each Needs

This table compares the main forms side by side. Overall, nerve tissue in the sac and an open skin surface both raise the urgency.

Type	What it is	Skin covered?	Usual operation	Timing
Spina bifida occulta	A small gap in one vertebra; the cord is usually normal	Yes	Usually none	Only if a tethered cord appears
Meningocele	A sac of fluid and membranes, without nerve tissue	Often	Sac removal and closure	Soon after birth if the skin is thin
Myelomeningocele	Spinal cord and nerves open in a sac on the back	No	Closure; shunt or ETV if needed	Within 48 hours of birth, or before 26 weeks in the womb
Lipomyelomeningocele	A fatty mass joined to the lower spinal cord	Yes, often with a lump	Lipoma removal and untethering	Planned case by case
Split cord malformation	A cord split in two by a spur or a band	Yes, often with a hairy patch	Spur or band removal and untethering	Type I: usually soon after diagnosis
Tight or fatty filum	A thick band that anchors the end of the cord	Yes	Filum release, a short operation	When symptoms appear

Can spina bifida be fixed in the womb?

Only the open form, and only in selected pregnancies at specialist fetal centers. Also, the repair must happen before 26 weeks of pregnancy. It reduces some problems, but it does not cure spina bifida.

Split cord malformation

Split Cord Malformation (Diastematomyelia) Surgery

In a split cord malformation, a bony or fibrous wall splits the spinal cord in two. Then, surgery removes this wall and frees the cord. As a result, the cord can move normally as the child grows.

Diastematomyelia is the older name for the same condition. It most often affects the lower back. In addition, surgeons divide it into two types:

Type I and type II: what is the difference?

Feature	Type I	Type II
Covering (dura)	Two separate tubes, one around each half	One tube shared by both halves
Dividing wall	A rigid spur of bone or cartilage	A thin fibrous band
Typical course	More often causes symptoms and tethering; often with vertebral anomalies	Often milder; sometimes found by chance
Operation	Spur removal outside the dura, then removal of the inner sleeves	Opening the dura and cutting the band

Signs that point to a split cord

Many children show a clue on the skin of the back. For example, a hairy patch over the spine is one of the most common signs:

A hairy patch, dimple or birthmark over the spine
One foot smaller, a high arch or a club foot
One leg thinner or weaker than the other
A spinal curve (scoliosis), back or leg pain
New bladder problems

How surgeons remove the spur and free the cord

Surgery takes place under general anesthesia, with constant monitoring of the leg and bladder nerves:

First, the surgeon opens the bone over the split (laminectomy).
Next, the surgeon removes the bony spur, working outside the dura first.
Then, the dura opens, and the sleeve between the two halves comes out.
After that, the surgeon cuts fibrous bands and a tight filum.
Finally, a watertight closure seals the dura behind the cord.

Should a child without symptoms have surgery?

For type I, many surgeons advise surgery soon after diagnosis, even without symptoms. In fact, deficits often appear during growth, and lost function does not always return.

In contrast, a type II split found by chance may only need regular checks. So, your surgeon weighs the scan, the examination and your child's age.

Is diastematomyelia the same as spina bifida?

Not exactly. Diastematomyelia means a split spinal cord, while spina bifida means an incomplete spine. However, the two often occur together, and surgeons treat them as related spinal defects.

Tethered cord

Tethered Cord Surgery (Untethering)

Tethered cord surgery frees the lower spinal cord from tissue that holds it down. As a result, the cord stops stretching when the child grows, bends or runs.

What tethers the spinal cord?

A tight or fatty filum terminale, the thin band at the end of the cord
A spinal lipoma or lipomyelomeningocele
Scar tissue after an earlier myelomeningocele repair
A split cord malformation or a dermal sinus
A spinal cord tumor or scar from earlier spine surgery

Symptoms in children

A dimple, hairy patch, fatty lump or skin mark on the lower back
Back or leg pain that worsens with activity
Changes in walking, leg strength or foot shape
A worsening spinal curve, or new bladder problems

How untethering works

The operation takes place under general anesthesia, through a small cut in the lower back. First, the surgeon removes a small piece of bone and opens the dura under the microscope. Then, nerve monitoring tells nerves apart from the filum.

Next, the surgeon cuts the filum or frees the scar and fat. Finally, a watertight closure seals the dura.

Retethering after spina bifida repair

After a myelomeningocele repair, the cord stays low, and scar can hold it down again. Therefore, surgeons decide on a new untethering from new symptoms, not from the MRI alone.

The AANS estimates that 20-50% of these children need untethering at some point. Often, the need appears during growth spurts, especially at puberty. Also, about 10-20% need a repeat operation.

Can a tethered cord come back after surgery?

Yes, sometimes. Scar can form again, especially after complex releases, and growth adds new stretch. For this reason, children stay in follow-up until they stop growing.

Does a tethered cord always need surgery?

No. Some children with a low cord and no symptoms only need regular checks. However, surgery helps when symptoms appear or get worse.

Adults

Spina Bifida Surgery in Adults

Adults with spina bifida need surgery less often than children. However, when they do, the reason is usually one of these:

A tethered cord, with back or leg pain, numbness or new bladder urgency
A split cord first noticed in adulthood
A shunt that blocks, often with headache and drowsiness
A Chiari malformation that presses on the brainstem

For example, a Turkish study followed 10 adults with a split cord. In six, symptoms began suddenly after sport or heavy lifting. After surgery, leg pain improved in all 10, but bladder problems improved in only 2 of 5.

Therefore, adults with new bladder symptoms should not wait long before seeing a specialist.

Safety

Risks, Recovery and Results

Spina bifida operations aim to stop decline, not to restore lost function. Nevertheless, many patients feel less pain and stay stable for years.

For example, a US study followed 3,682 children after tethered cord release. Within 30 days, 8.1% had a complication, most often a minor wound problem. Moreover, the average hospital stay was 2.7 days.

Main risks

A spinal fluid leak, or a fluid pocket under the wound
Wound infection
New or worse weakness, numbness or bladder function, which is uncommon

What results to expect

Pain often improves after surgery. Also, weakness and numbness may improve or stabilize. However, long-standing bladder problems improve less often.

How painful is tethered cord surgery?

The back feels sore and stiff for the first days, and medicines control the pain. Also, tiredness is common for a few weeks. After that, most children return to normal activities.

Planning

What Affects the Cost of Spina Bifida Surgery?

The cost depends mainly on the operation, the tests and the hospital stay. Therefore, two families rarely receive the same estimate.

Type of operation: a simple filum release is shorter than lipoma, split cord or repeat surgery
Monitoring and imaging: nerve monitoring, spine MRI, CT and bladder tests
Hospital stay: the number of nights and any intensive care
Implants and travel: a shunt valve, family accommodation and follow-up visits

Fetal surgery also costs more, because it needs a large specialist team.

How much does spina bifida surgery cost?

There is no single price. For example, a simple filum release costs far less than a split cord or lipoma operation. So, ask for a personal estimate after your child's examination.

Your treatment path

From Diagnosis to Recovery

Treatment follows four steps. Each step has a clear goal, so you always know what comes next.

01 Diagnosis
02 Planning
03 Surgery
04 Recovery

STEP 01

Diagnosis: what holds the cord?

First, the surgeon examines the back, legs, feet and reflexes. Then, imaging shows the level of the cord and anything that anchors it:

MRI of the whole spine shows the cord, fat, a split and any fluid cyst.
CT shows a bony spur in split cord malformation.
Ultrasound can screen the spine in young babies.
Urodynamic tests record bladder function before surgery.

Why does my child need a bladder test before surgery?

A urodynamic study shows how the bladder works today. It also gives a baseline, so the team can compare the results after surgery.

STEP 02

Planning: when is the right time?

Timing depends on the form. For example, an open defect needs closure within days of birth. Also, a type I split cord usually needs surgery soon after diagnosis.

In contrast, a tethered cord often waits until symptoms appear. Meanwhile, urology, orthopedics and physiotherapy join the plan, especially when the spine curves.

STEP 03

Surgery: free the cord, protect the nerves

On the day, your child sleeps under general anesthesia. Next, a thin bladder catheter goes in after they fall asleep. Then, the team monitors the leg and bladder nerves throughout.

Afterward, your child wakes in the recovery room and moves to the ward. Most children then lie flat for 24 to 72 hours to prevent a fluid leak.

How long does the operation take?

A simple filum release is a short operation. In contrast, split cord, lipoma and repeat releases take longer, often several hours.

STEP 04

Recovery: back to school and play

Next, children sit up step by step and walk with a physiotherapist. Then, they go home once they pass urine, eat well and feel comfortable.

Most return to normal activities within a few weeks. However, contact sports wait for the six-week check. Then, check-ups continue through growth, because the cord can tether again.

When can we fly home after surgery?

Usually after the wound check, once your child walks well and the wound stays dry. Then, the surgeon confirms the date at that visit.

Your surgeon

Spina Bifida Surgery in Istanbul

Prof. Dr. Serdar Baki Albayrak

Neurosurgeon · Spine and Spinal Cord Surgery

Spina bifida surgery works around nerves that control the legs and bladder. Therefore, Prof. Albayrak uses a microscope and nerve monitoring, and plans each step with the family.

27+Years

5,000+Operations

64Countries

Figures from Prof. Albayrak's professional profile, September 2026.

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FAQ

Frequently Asked Questions

Can spina bifida be cured with surgery?

No. Surgery closes the defect or frees the cord, which protects the function that remains. However, it cannot restore nerves that the defect already damaged.

Who performs spina bifida surgery?

A pediatric neurosurgeon performs most spina bifida operations. In addition, a plastic surgeon may join for large skin defects. Fetal repair also needs maternal-fetal specialists.

Does spina bifida get worse with age?

The defect itself does not grow. However, a tethered cord, a shunt problem or a spinal curve can cause new symptoms. So, regular checks during growth spurts catch these changes early.

Prof. Albayrak's Published Research

Peer-reviewed articles and book chapters written or co-written by Prof. Dr. Serdar Baki Albayrak on tethered spinal cord surgery in children. Each link opens the record on PubMed or at the publisher. The full list of his 33 publications is on his profile.

Tethered cord syndrome in childhood: special emphasis on the surgical technique and review of the literature with our experienceTurkish Neurosurgery, 2011 · Co-author

Public health information

NHS. Spina bifida.
National Institute of Neurological Disorders and Stroke. Tethered Spinal Cord Syndrome.

This page gives general medical information and does not replace a consultation. Diagnosis and treatment decisions need an examination by your own doctor.

Plan Spina Bifida Surgery in Istanbul

Request an appointment with Prof. Dr. Serdar Baki Albayrak. The clinical team then guides international families through every step of the visit.