Split spinal cord malformations: report of 22 cases and review of the literature.

Abstract

The aims of this study were to describe the embryological changes that drive the formation of a split spinal cord malformation, analyse the forms of presentation, evaluate the diagnostic procedures and discuss the indications for the different forms of therapy for each case. Clinical and radiological features of 22 cases of split spinal cord malformations (SSCM) are reported. Three groups of patients are considered: group a, patients with signs of tethered cord or scoliosis; group b, patients with midline cutaneous stigmata and group c, patients with a meningocele or meningomyelocele. While CT scan is particularly useful for the evaluation of vertebral bodies and posterior arch abnormalities and spur characteristics in SSCM, MRI gives complementary information on the anatomy of spinal cord, dural sac, conus and filum terminale and permits the exclusion of associated lesions such as hydro-syringomyelia, dermal sinus or dermoid and epidermoid cysts. Surgery should be considered indicated in all cases of SSCM, even the asymptomatic ones, except in very badly handicapped meningomyelocele patients with nonprogressive disability and type II SSCM.