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Related Experiment Videos

Split cord malformation: Part II: Clinical syndrome.

D Pang1

  • 1Pediatric Neurosurgery, Children's Hospital of Pittsburgh, Pennsylvania.

Neurosurgery
|September 1, 1992
PubMed
Summary

Split cord malformations (SCM) present differently in children and adults, with adults experiencing more pain and sensorimotor deficits. Hypertrichosis is a key indicator of SCM, and imaging techniques like CT myelography are crucial for diagnosis.

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Area of Science:

  • Neurosurgery
  • Pediatric Neurology
  • Radiology

Background:

  • Split cord malformations (SCM) are complex congenital anomalies affecting the spinal cord.
  • Understanding the clinical, radiographic, and surgical aspects of SCM is crucial for effective management.

Purpose of the Study:

  • To comprehensively analyze clinical, radiographic, and surgical findings in 39 patients with split cord malformations (SCM).
  • To compare the presentation and outcomes of SCM in adult versus pediatric populations.
  • To evaluate the efficacy of different imaging modalities in diagnosing SCM.

Main Methods:

  • Detailed retrospective analysis of 39 patients with SCM, including clinical, radiographic, and surgical data.
  • Classification of SCM based on established criteria (Type I, Type II, composite).

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  • Comparison of imaging findings between high-resolution CT myelography and MRI.

    • Main Results:

    • Adults with SCM predominantly presented with pain and progressive sensorimotor deficits, while children often had deficits without significant pain.
    • Hypertrichosis was the most common cutaneous manifestation and a strong predictor of SCM.
    • High-resolution CT myelography demonstrated superior sensitivity over MRI in defining SCM anatomical details.
    • Neurological deterioration was independent of SCM type or lesion location.
    • Surgical release of tethered hemicords is the primary goal, with Type I SCM posing greater technical challenges and surgical morbidity.

    Conclusions:

    • SCM exhibits distinct clinical presentations in adults and children, with unique features like left-right functional discrepancy in pediatric cases.
    • Advanced imaging, particularly CT myelography, is essential for accurate SCM diagnosis and surgical planning.
    • Surgical intervention aims to de-tether the spinal cord, though Type I SCM may involve higher surgical risks.