Incidentally discovered type 1 split cord malformation in an adult patient

Thoracolumbar surgery for degenerative spine diseases complicated with tethered cord syndrome: A case report

BACKGROUND

Tethered cord syndrome (TCS) secondary to split cord malformation (SCM) is rare in adulthood. There is as yet no consensus about the optimal treatment method for adult patients with SCMs and degenerative spine diseases such as lumbar stenosis, spondylolisthesis and ossification of the ligamentum flavum (OLF). The tethered cord poses a great challenge to the decompression and fusion procedures for the intraoperative stretching of the spinal cord, which might lead to deteriorated neural deficits. Here, we report on a case to add our treatment experience to the medical literature.

CASE SUMMARY

We treated a 67-year-old female patient with type II SCM suffering from lumbar disc herniation, degenerative lumbar spondylolisthesis and thoracic OLF. The patient underwent thoracolumbar spinal fusion and decompression surgery for severe lower back pain, extensive left lower limb muscle weakness and intermittent claudication. After the thoracolumbar surgery, without stretching the tethered cord, the patient achieved complete relief of pain and lower extremity weakness at final follow-up.

CONCLUSION

For adult patients with underlying TCS secondary to SCM coupled with thoracic OLF and lumbar spondylolisthesis, a thoracolumbar fusion surgery could be safe and effective with the tethered cord untreated. It is critical to design individualized surgical protocols to reduce the stretch of the low-lying spinal cord.

Horseshoe adrenal gland associated with type 1 diastematomyelia in an asymptomatic adult

A horseshoe adrenal gland is a rare congenital anomaly found almost exclusively in neonates and infants based on autopsy studies. It is a term used to describe a solitary adrenal gland situated in the midline, posterior to the inferior vena cava and abdominal aorta. To date, in the literature, there have been very few cases documented in adults and they have also been reported to be associated with other co-existing intra-abdominal, vascular and vertebral congenital anomalies. We describe a rare case of an asymptomatic adult patient who was incidentally found to have a horseshoe adrenal gland as well as a Type 1 diastematomyelia.