Spina Bifida and Medical Negligence in Chicago
Spina bifida is a neural-tube defect involving incomplete formation of the spine and, in some cases, the spinal cord and surrounding nerves. It develops very early in pregnancy when the neural tube does not form or close in the expected manner.
The medical effects vary considerably. Some people with a mild form have few or no symptoms. Others experience paralysis, reduced sensation, hydrocephalus, orthopedic problems, and lifelong bladder or bowel difficulties.
Most cases of spina bifida are not caused by medical malpractice. Researchers do not know the precise cause in many pregnancies. Genetic influences, folate levels, maternal health conditions, certain medications, fever or overheating, and other developmental factors may affect risk, but the diagnosis alone does not establish that a healthcare provider acted negligently.
A legal issue may arise in limited circumstances involving negligent medication management, a significant prenatal testing or imaging error, failure to communicate an abnormal result, inadequate delivery planning, or preventable harm during surgery or follow-up treatment.
Free legal evaluation: If your concern involves a particular medical error rather than the congenital condition alone, contact Sexner Injury Lawyers LLC or call (312) 243-9922.
How Spina Bifida Develops
During the earliest weeks of pregnancy, a structure called the neural tube forms and closes. The upper portion contributes to development of the brain and skull. The lower portion develops into the spinal cord and the bones and tissues that surround it.
Spina bifida can occur when the lower part of the neural tube does not close completely. The resulting abnormality can appear anywhere along the spine. The location and extent of the defect affect which nerves and body functions may be involved.
General medical information is available from the Centers for Disease Control and Prevention.
Common Types of Spina Bifida
The three most commonly recognized types are myelomeningocele, meningocele, and spina bifida occulta.
Myelomeningocele
Myelomeningocele is the most serious common form and is often called open spina bifida. A sac extends through an opening in the baby’s back and contains spinal-cord tissue and nerves. The exposed or displaced nerves are usually damaged.
The effects depend partly on the location of the opening. Possible consequences include weakness or paralysis below the affected level, reduced sensation, orthopedic abnormalities, and difficulty controlling the bladder or bowel.
Meningocele
With a meningocele, a fluid-filled sac containing the protective membranes around the spinal cord extends through an opening in the spine. The spinal cord itself ordinarily remains within the spinal canal.
Nerve damage is often less extensive than with myelomeningocele, although the child may still require surgical repair and continued evaluation.
Spina Bifida Occulta
Spina bifida occulta is generally the mildest form. One or more vertebrae have a small gap, but there is no exposed spinal-cord tissue or open sac on the back.
Many people have no symptoms and discover the condition incidentally later in life. Others may have an associated tethered spinal cord, fatty mass, skin marking, weakness, pain, or bladder and bowel problems.
Closed Spinal Dysraphism
The expression “closed neural-tube defect” or “closed spinal dysraphism” describes a group of abnormalities covered by skin. These can include a tethered spinal cord, lipomyelomeningocele, split-cord malformation, or another developmental difference involving the spine and nervous tissue.
Closed defects should not be treated as a fourth type identical to the three common forms listed above. Their severity and treatment depend on the particular anatomy and neurological findings.
Possible Health Effects
Each person with spina bifida has an individual combination of medical needs and abilities. Possible health issues include:
- Weakness or paralysis of the legs
- Reduced sensation below the affected spinal level
- Clubfoot, hip problems, scoliosis, or other orthopedic conditions
- Difficulty walking or need for braces, crutches, or a wheelchair
- Loss of bladder or bowel control
- Recurring urinary infections or kidney complications
- Hydrocephalus, involving excess fluid within the brain
- Chiari II malformation involving the lower part of the brain
- Tethered spinal cord
- Seizures in some individuals
- Learning, attention, or executive-function difficulties
- Skin injuries in areas with limited sensation
The presence of spina bifida does not mean that every person will experience all of these complications. Many people attend school, work, participate in sports, raise families, and live independently with appropriate medical and community support.
Folic Acid and Neural-Tube Development
Having enough folic acid before conception and during the earliest part of pregnancy reduces the likelihood of neural-tube defects. The CDC recommends that people capable of becoming pregnant obtain 400 micrograms of folic acid each day.
The timing matters because the neural tube closes before many people know that they are pregnant. Beginning supplementation only after a pregnancy is confirmed may be too late to provide its full preventive benefit.
Folic acid reduces risk but does not prevent every case. A child’s diagnosis should not be used to blame a mother for her diet, vitamin use, medical conditions, or pregnancy decisions.
A person who previously had a pregnancy affected by a neural-tube defect or who has another significant risk factor should discuss an individualized folic-acid plan with a qualified healthcare provider rather than changing the dosage without medical guidance.
Additional information is available from the CDC’s neural-tube defect resource.
Possible Causes and Risk Factors
The cause cannot be determined in many individual cases. Factors associated with an increased probability of spina bifida or another neural-tube defect include:
- Insufficient folate during early pregnancy
- Certain genetic influences
- Some antiseizure medications
- Diabetes that existed before pregnancy and was not adequately controlled
- High fever or significant overheating during early pregnancy
- A previous pregnancy involving a neural-tube defect
- A combination of inherited and environmental influences
A risk factor is not proof of causation. Its presence does not establish that the condition was preventable or that a physician failed to meet the standard of care.
Medication Use During Pregnancy
Certain antiseizure medications, particularly valproate, are recognized as increasing the probability of neural-tube defects when used during early pregnancy. However, prescribing an antiseizure medication is not automatically negligent.
Uncontrolled seizures, bipolar disorder, migraine conditions, and other maternal illnesses can also create serious risks. Medication decisions may require balancing maternal health, fetal risk, available alternatives, and the dangers of abruptly stopping treatment.
A case-specific medication review may consider:
- The exact medication and dose
- The medical condition being treated
- The timing and duration of use
- Whether pregnancy was known or reasonably foreseeable
- The risks of leaving the condition untreated
- Reasonably available alternatives
- The medical evidence and warnings available at the time
- Whether appropriate counseling and monitoring were provided
- Whether reliable expert evidence supports individual causation
SSRI antidepressants, contraceptives, antimetabolic medications, and broad medication categories should not be presented generally as established causes of spina bifida without reliable evidence involving the particular drug and circumstances.
A pregnant patient should not stop a prescribed medication without first discussing the risks and alternatives with an appropriate healthcare provider. Information about preventable prescribing and dispensing mistakes is available on our medication and prescription error page.
Prenatal Screening
Screening tests can indicate that a pregnancy has a higher probability of an open neural-tube defect, but a screening result is not itself a diagnosis.
Maternal Serum AFP
Alpha-fetoprotein, commonly abbreviated as AFP, is produced by the developing fetus. An elevated amount in maternal blood during the second trimester can be associated with open spina bifida or another fetal condition.
An abnormal result can also occur because the pregnancy dates are incorrect, more than one fetus is present, or for another reason unrelated to a neural-tube defect. Follow-up may include confirmation of gestational age, detailed ultrasound, repeat testing, genetic counseling, or additional diagnostic evaluation.
Prenatal Ultrasound
A detailed ultrasound may show an opening in the spine or changes in the shape of the fetal brain, skull, legs, or feet that suggest open spina bifida.
The ability to identify a defect can depend on:
- The stage of pregnancy
- The baby’s position and movement
- The location and size of the spinal abnormality
- The quality and completeness of the images
- The experience and responsibilities of the people obtaining and interpreting the study
- Whether the condition is open or covered by skin
Closed spinal defects and spina bifida occulta may be difficult or impossible to identify through routine prenatal ultrasound.
Additional Evaluation
When screening or imaging raises concern, the patient may be offered:
- Repeat or higher-resolution ultrasound
- Consultation with maternal-fetal medicine
- Fetal MRI for additional anatomical information
- Genetic counseling
- Amniocentesis or other diagnostic testing when medically appropriate
- Consultation with pediatric neurosurgery, neonatology, urology, or rehabilitation specialists
A Negative Screening Result Does Not Guarantee Detection
A child being born with spina bifida after prenatal screening does not automatically mean that malpractice occurred. Screening and imaging have recognized limitations, and some defects are substantially more difficult to detect than others.
A proper review may examine:
- Which tests were offered and accepted
- Whether the pregnancy was dated correctly
- Whether the test was performed during an appropriate period
- Whether accurate information was provided to the laboratory
- Whether required ultrasound views were obtained
- Whether an abnormal result was interpreted correctly
- Whether recommended follow-up occurred
- Whether the limitations of testing were explained
Planning Care After Prenatal Diagnosis
A prenatal diagnosis allows the family and medical team to evaluate associated conditions and plan for delivery and newborn treatment. The team may include maternal-fetal medicine, neonatology, pediatric neurosurgery, anesthesia, urology, orthopedics, rehabilitation, and genetics.
Planning may address:
- The location and extent of the spinal opening
- Leg movement and other neurological findings
- Hydrocephalus or changes in the fetal brain
- Associated orthopedic or organ abnormalities
- The timing, location, and method of delivery
- Whether prenatal surgery should be evaluated
- The expected care immediately after birth
Cesarean delivery is not automatically required in every case. The safest approach should be selected according to the anatomy, obstetric circumstances, and recommendations of the treating specialists.
Prenatal Surgery for Myelomeningocele
Selected pregnancies involving myelomeningocele may be evaluated for fetal surgery at a specialized center. The operation closes the spinal opening before birth in an effort to limit continuing injury to exposed nervous tissue.
Research has shown benefits for some carefully selected children, including a reduced need for a hydrocephalus shunt and improved motor outcomes. Prenatal surgery does not reverse all existing nerve damage or eliminate the need for lifelong care.
The procedure also presents substantial risks, which can include:
- Premature rupture of membranes
- Preterm delivery
- Placental complications
- Infection
- Risks associated with major surgery for the pregnant patient
- Requirements affecting the current delivery and some later pregnancies
Not every fetus or pregnant patient is medically eligible. The decision requires detailed evaluation, informed consent, and comparison with repair after birth.
Treatment After Birth
A baby with open spina bifida generally requires immediate protection of the exposed tissue and prompt neurosurgical care. Treatment may include:
- Covering and protecting the spinal opening
- Preventing contamination and infection
- Maintaining body temperature and hydration
- Evaluating movement, sensation, breathing, bladder, and bowel function
- Surgical closure of the opening
- Monitoring for hydrocephalus
- Assessment by urology, orthopedics, rehabilitation, and other specialists
Closing the opening protects the tissue and reduces additional injury, but it cannot necessarily restore function already lost because of abnormal spinal-cord development.
Hydrocephalus and Shunt Treatment
Many children with myelomeningocele develop hydrocephalus. Excess cerebrospinal fluid enlarges spaces within the brain and may create harmful pressure.
A neurosurgeon may place a shunt to drain fluid to another part of the body. Another treatment, such as endoscopic third ventriculostomy with choroid plexus cauterization, may be considered in selected children.
Shunts require continuing monitoring because they can become blocked, infected, disconnected, or otherwise malfunction. Symptoms may include vomiting, headache, sleepiness, irritability, seizures, changes in school performance, or neurological deterioration.
Long-Term Care
Spina bifida can affect several body systems throughout life. Ongoing care may involve:
- Neurosurgery and neurological monitoring
- Bladder and kidney care through pediatric urology
- Bowel-management programs
- Orthopedic treatment
- Physical and occupational therapy
- Braces, walkers, wheelchairs, or other mobility equipment
- Skin checks and pressure-injury prevention
- Educational and neuropsychological support
- Evaluation for tethered spinal cord
- Transition planning for adult medical care and independence
Additional treatment information is available from the CDC’s spina bifida management resource.
Most Cases Do Not Involve Medical Malpractice
The existence of spina bifida does not establish that a provider caused the condition. A viable malpractice matter generally requires proof of a separate departure from the applicable standard of care and reliable evidence that the failure caused legally recognized harm.
When Could Medical Negligence Be Relevant?
Negligent Medication Management
A legal review may be appropriate when a provider prescribed or continued a medication with a well-established neural-tube-defect risk without reasonably considering:
- Whether pregnancy was planned or possible
- Preconception counseling
- Safer medically appropriate alternatives
- The risks of changing or stopping treatment
- Folic-acid recommendations for a higher-risk patient
- Necessary coordination among specialists
- Warnings and informed decision-making
Even when medication management was unreasonable, qualified experts must still determine whether the exposure probably caused the child’s condition.
Prenatal Screening, Imaging, or Laboratory Errors
A case-specific review may be appropriate when:
- Appropriate screening options were not discussed
- An AFP result was calculated or interpreted incorrectly
- Incorrect pregnancy information was provided to a laboratory
- A significant spinal or brain abnormality visible on ultrasound was overlooked
- Required anatomical views were not obtained or documented
- Recommended follow-up imaging was not arranged
- A significant result was not communicated to the patient or another provider
- A specialist referral was unreasonably delayed
These concerns may overlap with a prenatal imaging error or a broader diagnostic-error claim.
Loss of an Opportunity for Specialist Evaluation
A delayed diagnosis does not automatically mean that fetal surgery would have been available or successful. Prenatal repair has strict medical eligibility requirements and is offered only at specialized centers.
A legal review may nevertheless examine whether negligent delay prevented timely evaluation for fetal surgery, appropriate counseling, specialist consultation, delivery planning, or other care that probably would have produced a meaningful medical benefit.
Wrongful Birth Claims
Illinois law distinguishes a parental wrongful-birth claim from a wrongful-life claim brought on behalf of a child.
In limited circumstances, a wrongful-birth claim may allege that negligent screening, testing, counseling, interpretation, or communication deprived the parents of accurate prenatal information and the opportunity to make an informed decision.
Such a claim does not ordinarily allege that the provider caused spina bifida. Illinois does not recognize wrongful-life claims. The viability of a wrongful-birth claim depends on the facts, medical evidence, causation, damages, and current Illinois law.
Delivery and Newborn-Care Errors
A separate birth-injury issue may arise when preventable additional harm results from:
- Failure to protect exposed spinal tissue
- Trauma or contamination during delivery or initial care
- Unreasonable delay in obtaining neonatal or neurosurgical treatment
- Failure to recognize breathing problems, infection, hydrocephalus, or neurological deterioration
- Inadequate newborn stabilization or monitoring
Negligent Surgery or Follow-Up
Spina bifida treatment involves serious risks even when care is appropriate. A complication or poor outcome does not by itself establish negligence.
A legal issue may exist when preventable harm results from:
- Inadequate surgical planning
- Damage to viable spinal-cord or nerve tissue
- A preventable surgical error
- An anesthesia, medication, or monitoring mistake
- Failure to recognize infection, wound breakdown, spinal-fluid leakage, or neurological decline
- Failure to diagnose or treat hydrocephalus or a malfunctioning shunt
- Failure to recognize tethered-cord symptoms
- Inadequate urological, orthopedic, rehabilitation, or long-term follow-up
Records Used to Evaluate a Potential Case
A medical and legal review may require:
- Preconception, prenatal, and obstetric records
- Medication and pharmacy records
- Pregnancy-dating information
- Maternal serum AFP orders and results
- Ultrasound reports and original images
- Fetal MRI studies
- Maternal-fetal medicine and genetic-counseling records
- Fetal-surgery referral and eligibility records
- Delivery-planning and fetal-monitoring records
- Newborn intensive-care and neurosurgical records
- Operative and anesthesia reports
- Brain and spine imaging
- Shunt, urology, orthopedic, therapy, and rehabilitation records
- Developmental, educational, and long-term follow-up documentation
Qualified experts may need to distinguish the effects of congenital spinal-cord development from any additional injury allegedly caused by medication management, delayed diagnosis, surgery, or inadequate follow-up.
Contact Sexner Injury Lawyers LLC
Most children with spina bifida do not have a medical malpractice claim. A legal evaluation may be appropriate when there is a specific concern involving medication management, prenatal testing, interpretation or communication of results, specialist referral, delivery planning, surgery, or follow-up care.
Contact Sexner Injury Lawyers LLC or call (312) 243-9922 for a free and confidential evaluation. We will explain honestly whether the circumstances appear to justify further investigation.
