Split cord malformation: experience from a tertiary referral center

Do we need to scan the whole neuraxis for coexistent abnormalities in children with surgically treated occult spinal dysraphism?

BACKGROUND

Spina bifida occulta (SBO) is generally known as a benign isolated entity; however, there are ambiguous approaches for neuroaxial screening in cases of symptomatic SBO among institutions. This study aims to demonstrate the infrequency of cranial anomalies associated with symptomatic SBO and inquire the necessity of cranial radiological surveillance in those patients.

METHODS

Between 2012 and 2016 pediatric patients who were surgically treated in our clinic due to symptomatic SBO were retrospectively evaluated. All radiological findings in craniospinal evaluation were documented.

RESULTS

There were 76 patients with mean age of 5.3 years (range 2 months to 17 years), and female predominance (53 female and 23 male patients). Of those, 64 patients had whole neuroaxis investigation including cranial imaging. Among 64 patients with cranial screening, only two patients had occipital encephalocele and posterior fossa arachnoid cyst. There was neither hydrocephalus nor Chiari malformation in our case series.

CONCLUSIONS

We detected high number of additional spinal abnormalities accompanying to symptomatic SBOs, whereas cranial findings rarely coexisted with them. Therefore, we strongly suggest the radiological screening of whole spinal axis in occult spinal dysraphism with significant spinal findings. On the other hand, cranial imaging as a part of neuraxis screening in cases of symptomatic SBOs is not required in all cases; however, it can be done in selected patients where clinically indicated.

STUDY DESIGN: CASE SERIES OF 19 PATIENTS OPERATED FOR SEVERE SCOLIOSIS AND DIASTEMATOMYELIA

ABSTRACT Objective: Diastematomyelia is a rare congenital spine and spinal cord malformation in which the spinal cord is divided into two parts by the osseous or fibrous septum. The incidence of diastematomyelia in patients with the most severe forms of congenital scoliosis is much higher than its general incidence in the population. When performing surgeries to correct scoliotic deformities, the question arises regarding the choice of a strategy for managing the septum. An unambiguous answer to this question does not exist, since the disease is very rare and heterogeneous. The aim was to summarize the data on different surgical strategies for detecting diastematomyelia. Methods: Literature review and retrospective analysis of our own clinical data. Results: We present our own experience of treating 19 patients with diastematomyelia and severe congenital scoliosis. Posture disorder was corrected in all cases; the septum was removed in none of the cases. Significant correction was achieved for all patients, and no neurological complications were observed in the short- and long-term follow-up. Conclusions: Surgical nonremoval of the spur enables compensation to be achieved, without neurological complications either in the immediate postoperative period or in the long-term (more than 2 years) follow-up. Level of Evidence IV; Case seriesh.

Split spinal cord malformation: report of 5 cases in a single Chinese center and review of the literature

BACKGROUND

Split spinal cord malformation (SSCM) is rare in scoliosis. This study evaluated the safety and effectiveness of one-stage surgical treatment of congenital scoliosis (CS) in patients with SSCM in a single Chinese center.

METHOD

A retrospective study of 5 cases who underwent surgery for CS with SSCM (2 type I and 3 type II) from March 2004 to March 2012. Patients included 4 females and 1 male with a mean age of 13.8 years. All patients underwent one-stage posterior fusion surgery with resection of a bony spur firstly in SSCM type I, but we did nothing to the SSCM in type II. Clinical symptoms and radiological changes were evaluated preoperatively and for at least 2 years postoperatively.

RESULTS

Preoperatively, 5 patients had variant neurological and other symptoms. They had a mean preoperative Cobb angle of 63 ± 20° and T5-T12 kyphosis of 30 ± 21°. The mean postoperative Cobb angle was 30.2 ± 19.8° with a correction rate of 57.2 ± 17.0%. At the 3-month follow-up the Cobb angle loss was 3.0 ± 6.8°, and at the 2-year follow-up the Cobb angle loss was 6.5 ± 9.7°. Hyperkyphosis was significantly corrected after surgery but correction loss was indicated at the 2-year follow-up (p < 0.01). There were no neurological deficit complications or deteriorated neurological signs postoperatively or at follow-up.

CONCLUSIONS

One-stage surgical treatment of CS with SSCM could be safe and effective, but we need further multicenter studies with larger samples. Intraspinal intervention of bone spur was recommended in SSCM type I before deformity correction, while in SSCM type II it was needless.