SPLIT CORD MALFORMATIONS: EXPERIENCE AT ALL INDIA INSTITUTE OF MEDICAL SCIENCES (AIIMS), NEW DELHI, INDIA
Split cord malformations (SCMs) are uncommon forms of spinal dysraphism, often associated with other anomalies like myelomeningocele, neurenteric cyst, etc. Although unified theory of embryogenesis explains most of the cases of SCMs, however some complex types like SCM with posterior spur cannot be reasonably explained. Magnetic resonance imaging complemented by computed tomography scan is the best imaging modality to know the exact orientation bony septum as well as cord spliiting. Surgical excision of the spur with detethering of filum, in cases of low-lying conus, is the treatment of choice in which laminectomy with gradual drilling of the dorsally located spur should be done. The risk of post-operative worsening of the neurological status is increased in cases in which there is concomitant presence of hypertrophic posterior arch and low-lying conus. A detailed pre-operative clinico-radiological assessment to identify any associated pathology and good operative skills and technique can help achieve satisfactory results without causing further spinal-cord damage.
Ashok Kumar Mahapatra
Bhubaneswar, In
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