Pattern of Presentation, Management Challenges and Surgical Outcomes of Spina Bifida in Children at a Nigerian Tertiary Hospital: A Five-year Retrospective Study

Abstract

Background: Spina bifida remains a major cause of childhood disability in low-resource settings, where delayed presentation and limited access to specialised neurosurgical care contribute to poor outcomes. This study evaluated the pattern of presentation, management challenges and early surgical outcomes of children with spina bifida managed at a Nigerian tertiary hospital. Methods: A five-year retrospective study involved 80 children who underwent surgical repair of spina bifida. Data on demographics, clinical presentation, operative management, postoperative complications and outcomes were extracted from hospital records. Bivariate and multivariable logistic regression analyses were performed to identify predictors of poor surgical outcome. Results: Eighty children were included, with a mean age at presentation of 1.8 ± 2.4 months; 57.5% presented during the neonatal period. Myelomeningocele was the predominant lesion (86.3%), and hydrocephalus was present in 60.0% of patients. Delayed presentation beyond 72 hours occurred in 56.3%. Overall, 27 (33.8%) children developed postoperative complications; the most frequently reported were new postoperative hydrocephalus requiring ventriculoperitoneal shunt insertion (16.3%), surgical site infection (12.5%) and cerebrospinal fluid leakage (10.0%). Seventy-four (92.5%) survived to hospital discharge, while 57 (71.3%) achieved a good surgical outcome. Delayed presentation (AOR 4.62, 95% CI 1.39–15.37), hydrocephalus (AOR 3.89, 95% CI 1.16–13.04), ruptured or leaking sac (AOR 3.45, 95% CI 1.09–10.90) and preoperative sepsis (AOR 3.71, 95% CI 1.08–12.76) independently predicted poor outcomes. Conclusion: Although favourable early surgical outcomes were achieved in most children, delayed presentation, hydrocephalus, sac rupture and preoperative sepsis remained important determinants of poor outcomes. Earlier referrals, timely surgical intervention and improved access to specialised multidisciplinary care may further improve outcomes.