Split cord malformation with dorsally located bony spur: Report of four cases and review of literature
A 2-year-old male child presented to the neurosurgical outpatient services with features of scoliotic deformity of the dorsal spine including urinary and fecal incontinence. The neurological examination revealed dorsal kyphoscoliosis and mild asymmetrical paraparesis. There was no evidence of cutaneous stigmata of neural tube defects.\nA magnetic resonance (MR) imaging of the whole spine showed features of SCM type I, with a bony spur at the D12–L1 vertebral level. A long-segment syrinx and low-lying conus at the L3 vertebral level was observed with tethering of the cord [Figure –]. Further, a plain computed tomography (CT) scan of the dorso-lumbar spine confirmed the bony origin of the spur with the spur arising from the posterior elements of the D12 vertebra and ending just short of the vertebral body []. The other associated bony anomalies included a hypertrophied posterior arch (HPA) at the level of spur and dysraphic spinous process. Intra-operatively, the incomplete dorsal bony spur was removed completely, the two dural tubes were converted into a single tube and detethering of the filum was performed. Post-operatively, the child developed mild worsening of paraparesis. At follow-up of 1 year following surgery, the child had improvement in paraparesis and autonomic dysfunction.