Unusual splitting of cord defying the Pang's classification

Abstract

A 2-year-old boy presented to us with history of inability to walk without support. There was no associated wasting or history of cuts and burns on lower limbs. He seemed unable to detect the urge to urinate or defecate. There was no history of deformity of feet, limbs or spine. On examination of spine, the spinous processes could not be felt in lumbar region. The power in lower limbs was 3–4/5. The sensations were preserved in bilateral lower limbs and deep tendon reflexes were diminished, there was no deformity of feet. Perianal sensations were intact and anal reflex and tone was also normal. The child was subjected to urodynamic testing, where compliance and bladder capacity was reported to be normal. Suspecting a diagnosis of tethered cord syndrome, a magnetic resonance imaging (MRI) of craniospinal axis was done. MRI revealed a split cord malformation at L3–4 levels with malformation of posterior elements of spine and low-lying cord at L4 level. A fibrocartilaginous septum was dividing the cord into two halves on MRI (Figs 1 and 2). An associated hydromyelia was present at D7 to L1 level. A radiological diagnosis of split cord malformation (SCM) type I with proximal hydrosyrinxwas made and surgery