J Korean Neurosurg Soc.  2013 Oct;54(4):363-365. 10.3340/jkns.2013.54.4.363.

Split Cord Malformation Combined with Tethered Cord Syndrome in an Adult

• Kim YD
• Sung JH
• Hong JT
• Lee SW

• KMID: 1499347
• DOI: http://doi.org/10.3340/jkns.2013.54.4.363

Abstract

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.

Keyword

Split cord malformation; Adult; Tethered cord syndrome

MeSH Terms

Adult*
Back Pain
Female
Follow-Up Studies
General Surgery
Humans
Neck Pain
Neural Tube Defects*
Paraparesis
Spinal Dysraphism

Figure

• 

  Fig. 1 Plain radiograph of thoracic spine reveals scoliosis at the cervicothoracic junction, hemi-vertebrae (arrowhead), and spina bifida (white arrow). B : Coronal section MR image shows the evidence of clefting of the cervicothoracic spinal cord and vertebral dysgenesis. C : Axial T2-weighted image shows the spinal cord is split into two hemi-cords within the single dural sac at the thoracic level. Common midline arachnoid space is identified between the two hemi-cords. Abnormal fat tissue accumulation is noted between the bifid spinous processes (arrow). D : Sagittal T2-weighted MR image shows the low-lying conus medullaris tethered posteriorly in the spinal canal.

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  Fig. 2 Axial CT myelography shows the presence of fibrous septum which extends to the epidural space and is attached into the lamina.

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  Fig. 3 Intra-operative image shows a fibrous septum (arrow) splits and tethers spinal cord (A). Location of fibrous septum is far above the level of the spinal cord duplication (B).

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  Fig. 4 Black arrow indicates the thickened filum terminale before untethering (A). Location of filum terminale ascends just after untethering procedure (B).

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