A split cord malformation with paresis of the unilateral lower limb: case report

A Patient with a Type I Split Cord Malformation and an Open Myelomeningocele without Advanced Lower Limb Paresis: A Case Report and a Review of the Literature

We report a rare case of a split cord malformation (SCM) combined with an open myelomeningocele (MMC) on the right hemicord. The patient was a male neonate, who exhibited an MMC in the lumbosacral region at birth. Both of his lower limbs moved with slight spasticity, but no atrophic changes or clubfoot deformities were seen. Three-dimensional computed tomography (CT) demonstrated a bony septum, and the patient was diagnosed with a type I SCM. Magnetic resonance imaging (MRI) showed an MMC on the right hemicord (a hemimyelomeningocele). The repair of the open MMC and the removal of the septum were performed immediately to prevent infection and neurological deterioration. Intraoperatively, the right hemicord was thinner than the left hemicord. No additional neurological deficits or complications appeared during treatment. Our findings suggest that when a minor hemicord is affected by both an SCM and an open MMC, good functional outcomes of the lower limbs can be achieved.

Split cord malformation combined with tethered cord syndrome in an adult

Split cord malformations (SCMs) usually present in childhood, and are rarely reported in adults. And also, a cervicothoracic SCM associated with tethered cord syndrome has very rarely been reported in the literature. We report a case of SCM associated with tethered cord and spina bifida in an adult. This report describes the case of a 34-year-old woman who presented for evaluation of neck pain, back pain, and intermittent paraparesis of several months duration. The MRI and CT showed a SCM at the cervicothoracic level and a fibrous septum at the thoracic level. She underwent surgery for the SCM and tethered cord syndrome, and was followed for 7 years. Patient presented complete recovery in the follow-up. The authors discuss this unusual lesion and describe the anatomical relationship of the level of cord duplication and fibrous septum.

Split cord malformation types I and II: a personal series of 131 patients

PURPOSE

A personal series of 131 patients with split cord malformation (SCM) operated on is presented.

METHODS

Age, gender, symptoms and signs, radiological and operative findings, complications, associated anomalies, outcome, and pathological specimens were analyzed.

RESULTS

There were 88 girls (73 %) and 43 boys (27 %). The female predominance was slightly more remarkable in type I SCMs than in type II SCMs. The presenting symptoms can be summarized as skin lesions, spina bifida aperta, scoliosis or kyphoscoliosis, sphincter disturbance, foot deformities and weakness, and/or atrophy in the lower extremities. The ages of patients with neurological deficits and orthopedic deformities were significantly older than those without deficits (P = 0.030). The duration of symptoms was longer in the patients with neurological deficits and orthopedic deformities than that in those without deficits (P = 0.00095). In six patients, composite SCMs were present. Only one patient with a type II SCM did not have an associated spinal cord lesion. A type I SCM was more frequently encountered in patients with spina bifida (P < 0.0005). Transient postoperative complications were seen in 29 patients (22 %). There was no permanent complication. Retethered cord syndrome developed in five patients with a type I SCM.

CONCLUSIONS

The risk of neurological and orthopedic deficits increases with the age of the patient. The risk of permanent deficit after surgery is very low. The whole spine must be examined for additional lesions. All patients should be surgically treated when diagnosed, especially before the development of orthopedic and neurological manifestations, and all associated lesions should also be treated at the same session.

An exceptional case of complete lumbosacral spine duplication and open myelomeningocele in adulthood

The authors describe the case of a 47-year-old woman with a wide (14 × 12-cm) ulcerated lumbosacral myelomeningocele. The patient had sought medical attention for a sudden copious CSF leak from the lumbosacral sac followed by clinical signs of CSF leakage. After admission, neuroradiological assessment (spinal MR and 3D CT imaging) revealed the uncommon finding of a complex malformation characterized by a complete spine duplication originating at the L2-3 level, both hemicords having a separate dural sac. The myelomeningocele sac originated medially at the L-2 level. Surgical repair of the lumbosacral myelomeningocele was performed. The placement of a ventriculoperitoneal shunt became necessary to treat secondary hydrocephalus. After reviewing accredited classifications on spinal cord malformations, the authors believe that, to date, complete duplication and separation of the spine and dural sac seems exceptional, and its report in adulthood appears exceedingly rare.