Split spinal cord malformation in an elderly patient: case report.

Area of Science:

• Neurology
• Neurosurgery
• Developmental Biology

Background:

• Split spinal cord malformation (SCM) is a rare congenital anomaly, typically diagnosed in childhood.
• Adult and elderly presentations of SCM are exceptionally uncommon, often leading to delayed or missed diagnoses.
• Understanding SCM in the elderly is crucial due to its potential for subtle, progressive neurological deficits.

Observation:

• A 73-year-old woman with a history of scoliosis and delayed motor milestones presented with worsening low back pain and gait disturbance.
• MRI revealed a bifid spinal cord within a single thecal sac, a tethered cord, and a low-lying conus medullaris.
• Physical examination showed 4/5 weakness in left ankle dorsiflexion.

Findings:

• Surgical intervention involved removing a fibrous median septum and adhesions, followed by division of the filum terminale.
• Post-operatively, the patient experienced reduced back pain, improved ambulation, and decreased reliance on pain medication.
• Neurological recovery was noted, with left ankle dorsiflexion strength improving to 4+/5.

Implications:

• This case underscores the necessity of including split cord malformation and tethered cord in the differential diagnosis for elderly patients presenting with back pain, scoliosis, and ambulatory issues.
• Early recognition and surgical management of SCM in older adults can lead to significant symptomatic improvement.
• Further research into the long-term outcomes and diagnostic challenges of SCM in the elderly population is warranted.