Clinical analysis of 225 cases of split cord malformation in children

Abstract

Objective To explore the clinical characteristics, diagnosis and treatment of split cord malformation (SCM) in children. Methods From January 2005 to July 2016, a consecutive of 225 SCM cases were treated. There were 77 boys and 148 girls with a mean age of (5.8±3.1) years (3 days to 16 years). The age of treatment was from 3 days to 1 month (n=14), 1 month to 1 year (n=65) and 1 to 16 years (n=146). Septums were located at cervical spine (n=3), thoracic spine (n=105), lumbar spine (n=117), both thoracic and lumbar spine (n=5) and from cervical to lumbar spine (n=1). The Pang's types were I (n=172), II (n=47) and complex (n=6). Lower limb muscle strength, bladder post-void residual volume and electrophysiological pre and postoperatively were compared. Results All of them underwent spinal cord septum ablation with a simultaneous or staged release of tethered cord deformity. The follow-up period was from 1 to 11 years. The outcomes were cured (n=47), symptomatic improvements (n=71), marked symptomatic improvements (n=96) and unchanged (n=11). All of them received urinary ultrasonography and bladder post-void residual volume after surgery. The mean postoperative volumes of all 3 types were (26.7±18.2)ml, (18.2±7.9)ml and(59.9±33.6)ml versus (59.4±47.2) ml, (46.6±27.3) ml and (103.9±54.6) ml at pre-operation. And the differences were statistically significant (P<0.05). After surgery, posterior tibial nerve electrophysiological test was performed. The mean values of evoked potential amplitude, nerve conduction velocity and latent potential were (7.23±4.52) mV, (51.34±6.33) m/s and (3.81±0.59) ms versus (4.71±3.81) mV, (38.59±5.39) m/s and (7.73±0.54) ms at pre-operatively. And the differences were statistically significant(P<0.05). Conclusions Though rare, SCM is frequently associated with other deformities of spinal cord. Skin lesion on back, abnormal development of both lower limbs and scoliosis may facilitate an early diagnosis. Microsurgical surgery may prevent further development of nerve injury and reduce existing symptoms. Key words: Diastematomyelia; Electrophysiologic study; Microsurgery