Is It Better to Resect a Bony Spur Before Corrective Surgery for Congenital Scoliosis with Type I Split Cord Malformation?

Abstract BACKGROUND Single-stage spine-shortening osteotomy without treating spinal cord malformations may have potential advantages for the treatment of severe congenital scoliosis (CS) with type I split spinal cord malformation (SSCM); however, the study of this technique was limited. OBJECTIVE To evaluate the safety and efficacy of a single-stage spine-shortening osteotomy in the treatment of severe CS associated with type I SSCM. METHODS A retrospective study was designed to compare 2 case series including 12 severe CS patients with type I SSCM and 26 patients with type A cord function (without spinal cord malformations, evoked potential abnormalities, and neurological dysfunctions preoperatively) treated with a single-stage spine-shortening posterior vertebral column resection (PVCR). Patient demographic, clinical, operative, and radiographic data were obtained and compared between groups. RESULTS The surgical procedure was successfully performed in both groups, and the patients were observed for an average of 44.9 mo (range 25-78 mo) after the initial surgery. The radiographic parameters, intraoperative data, and new neurological deficits showed no difference, while deformity angular ratio (SSCM group: control group = 16.6 ± 3.6: 20.1 ± 3.9, P = .01) and corrective rate (SSCM group: control group = 50%: 58%, P = .046) of the main curve were statistically different between groups. All of the new neurological deficits were recovered within 1 yr. CONCLUSION The single-stage spine-shortening PVCR with moderate correction could be applied to the treatment of CS associated with type I SSCM. This strategy can achieve safe spinal deformity correction while obviate the neurological complications brought by the detethering procedures, which merits further clinical investigation.

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Expert’s comment concerning Grand Rounds case entitled “Staged corrective surgery for complex congenital scoliosis and split cord malformation” (by Muhammad Asad Qureshi, Ambreen Asad, Ibrahim Farooq Pasha, Arslan Sharif Malik, Vincent Arlet)

European Spine Journal ◽

10.1007/s00586-009-1098-2 ◽

2009 ◽

Vol 18 (9) ◽

pp. 1255-1256 ◽

Cited By ~ 1

Author(s):

Azmi Hamzaoglu

Keyword(s):

Congenital Scoliosis ◽

Split Cord Malformation ◽

Corrective Surgery ◽

Grand Rounds

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Lipomeningocele associated with diplomyelia in a dog

Tierärztliche Praxis Ausgabe K Kleintiere / Heimtiere ◽

10.15654/tpk-170751 ◽

2018 ◽

Vol 46 (05) ◽

pp. 323-329 ◽

Cited By ~ 2

Author(s):

Nele Ondreka ◽

Sara Malberg ◽

Emma Laws ◽

Martin Schmidt ◽

Sabine Schulze

Keyword(s):

Spinal Cord ◽

Neurological Status ◽

Split Cord Malformation ◽

Lumbar Spinal Cord ◽

Histopathological Diagnosis ◽

Type I ◽

Thoracic Spinal Cord ◽

Thoracic Spinal ◽

Subcutaneous Mass ◽

Lumbar Spinal

SummaryA 2-year-old male neutered mixed breed dog with a body weight of 30 kg was presented for evaluation of a soft subcutaneous mass on the dorsal midline at the level of the caudal thoracic spine. A further clinical sign was intermittent pain on palpation of the area of the subcutaneous mass. The owner also described a prolonged phase of urination with repeated interruption and re-initiation of voiding. The findings of the neurological examination were consistent with a lesion localization between the 3rd thoracic and 3rd lumbar spinal cord segments. Magnetic resonance imaging revealed a spina bifida with a lipomeningocele and diplomyelia (split cord malformation type I) at the level of thoracic vertebra 11 and 12 and secondary syringomyelia above the aforementioned defects in the caudal thoracic spinal cord. Surgical resection of the lipomeningocele via a hemilaminectomy was performed. After initial deterioration of the neurological status postsurgery with paraplegia and absent deep pain sensation the dog improved within 2 weeks to non-ambulatory paraparesis with voluntary urination. Six weeks postoperatively the dog was ambulatory, according to the owner. Two years after surgery the owner recorded that the dog showed a normal gait, a normal urination and no pain. Histopathological diagnosis of the biopsied material revealed a lipomeningocele which confirmed the radiological diagnosis.

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CONGENITAL SCOLIOSIS ASSOCIATED WITH COEXISTENT SPLIT CORD MALFORMATION (SCM) AND INTRAMEDULLARY TERATOMA: REPORT OF A CASE

Journal of Musculoskeletal Research ◽

10.1142/s0218957708001948 ◽

2008 ◽

Vol 11 (01) ◽

pp. 15-19

Author(s):

Qibin Ye ◽

Duanming Li

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Spinal Canal ◽

Congenital Scoliosis ◽

Split Cord Malformation ◽

Resonance Imaging ◽

Scoliotic Curve ◽

Operative Exploration ◽

Magnetic Resonance Imaging Mri ◽

Surgical Corrections

A 9-year-old girl with congenital scoliosis, split cord malformation (SCM), and intramedullary teratoma was reported at the authors' institution. She had undergone three surgical corrections of the scoliosis without recognition of the existing teratoma, which was only revealed in a subsequent operative exploration of the spinal canal due to progressive neurological deficiency. The SCM was at the T9 level, and the teratoma at levels T10–T12. The teratoma was removed and the scoliotic curve was further corrected. These procedures resulted in restoring normal neurological function. This case shows that congenital scoliosis may coexist with other intraspinal deformities, and may be left unnoticed. Magnetic resonance imaging (MRI) is considered as a valuable means for the diagnosis of intraspinal teratoma.

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A Case of Split Cord Malformation with Triple Bony Spur in a Single Dural Sleeve—A Classification Dilemma

Indian Journal of Neurosurgery ◽

10.1055/s-0038-1670019 ◽

2018 ◽

Vol 07 (03) ◽

pp. 275-277

Author(s):

Saurabh Verma ◽

Madakasira Sridhar ◽

Manish Garg

Keyword(s):

World Literature ◽

Split Cord Malformation ◽

Unique Case ◽

Dural Sac ◽

The World ◽

Asymmetrical Division ◽

Bony Spur

AbstractSplit cord malformation-I (SCM-I) is characterized by the presence of double dural sacs, with rigid extradural bony/cartilaginous spur leading to symmetrical or asymmetrical division of the cord. In split cord malformation-II (SCM-II), there is a single dural sac with a nonrigid fibrous spur and symmetrical division of the cord. SCM-II are slightly more common than SCM-I, constituting around 50 to 60% of SCMs. The authors report a unique case of SCM with triple bony spurs lying both intra- and extradurally in a single dural sleeve. At the time of submission of this report, to the best of authors’ knowledge, no case of SCM with triple bony spurs in single dural sleeve has been reported anywhere in the world literature.

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Limited Dorsal Myeloschisis with and without Type I Split Cord Malformation: Report of 3 Cases and Surgical Nuances

Medicina ◽

10.3390/medicina55020028 ◽

2019 ◽

Vol 55 (2) ◽

pp. 28

Author(s):

Yusuf Izci ◽

Cahit Kural

Keyword(s):

Spinal Cord ◽

Tethered Cord ◽

Intraoperative Neuromonitoring ◽

The Other ◽

Split Cord Malformation ◽

Type I ◽

Cystic Lesions ◽

Rare Form ◽

Urological Complications ◽

Spinal Malformations

Limited dorsal myeloschisis (LDM) is a rare form of spina bifida which is characterized by a fibroneural stalk between the inner part of the skin and the spinal cord. It may be associated with split cord malformation (SCM). Diagnosis and management of this complex malformation is challenging. We presented 3 different cases of LDM. Two of them were associated with Type I SCM and the other had no associated malformation. All of them were evaluated radiologically just after the birth and underwent surgical treatment under intraoperative neuromonitoring. They discharged without any complication. Newborns with spinal cystic lesions should be carefully evaluated for spinal malformations after the birth and treated surgically as soon as possible in order to prevent neurological and urological complications secondary to tethered cord syndrome. Surgical technique in LDM-SCM patients is quite different than the patients with solitary LDM.

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