Abstract
ABSTRACT Objective: Diastematomyelia is a rare congenital spine and spinal cord malformation in which the spinal cord is divided into two parts by the osseous or fibrous septum. The incidence of diastematomyelia in patients with the most severe forms of congenital scoliosis is much higher than its general incidence in the population. When performing surgeries to correct scoliotic deformities, the question arises regarding the choice of a strategy for managing the septum. An unambiguous answer to this question does not exist, since the disease is very rare and heterogeneous. The aim was to summarize the data on different surgical strategies for detecting diastematomyelia. Methods: Literature review and retrospective analysis of our own clinical data. Results: We present our own experience of treating 19 patients with diastematomyelia and severe congenital scoliosis. Posture disorder was corrected in all cases; the septum was removed in none of the cases. Significant correction was achieved for all patients, and no neurological complications were observed in the short- and long-term follow-up. Conclusions: Surgical nonremoval of the spur enables compensation to be achieved, without neurological complications either in the immediate postoperative period or in the long-term (more than 2 years) follow-up. Level of Evidence IV; Case seriesh.
Highlights
Diastematomyelia, known as split cord malformation (SCM), is a congenital anomaly of the spinal cord and spine in which the spinal cord is split into two parts
There are three variants of the surgical approach to the patient with progressive congenital scoliosis who is diagnosed with diastematomyelia: 1. Resection of the intracanal spur in all cases, before the scoliosis correction surgery; 2
We believe that further accumulation of clinical data and the development of a differentiated approach to the choice of a surgical approach are required
Summary
Diastematomyelia, known as split cord malformation (SCM), is a congenital anomaly of the spinal cord and spine in which the spinal cord is split into two parts. Diastematomyelia is one of the variants of the closed form of spinal dysraphism.[1] SCM was first described by Olivier in 1837.2 According to the literature, the rate of SCM in patients with congenital scoliosis is very variable and ranges from 4.9%3 to 41%.4. SCM has two aspects: neurosurgical and orthopedic. The neurosurgical aspect is that the risk for the development and progression of neurological symptoms due to traction on the spinal cord by the separating spur increases with the patient’s age. The orthopedic aspect involves problems related to full surgical correction of spinal deformities in the presence of the spur separating the spinal cord
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