Adult-onset presentation of cervicothoracic split cord malformation: illustrative case

A 60-year-old female presented with a 6-month history of progressive lower limb pain, weakness, and declining mobility. She was initially diagnosed as having possible hip osteoarthritis or ligamental knee injury. She was eventually seen by a neurologist, who admitted her to a tertiary hospital with new-onset upper motor neuron signs and urinary incontinence. Magnetic resonance imaging of the whole spine revealed evidence of C7-T2 type 1 split cord malformation (SCM) necessitating urgent spinal surgery. She had an excellent outcome with intensive rehabilitation and returned to her premorbid level of function and mobility.

The patient presented with nonspecific symptoms, which led to multiple referrals and a significant delay in her diagnosis.

Clinicians should be aware of the importance of a detailed history with thorough neurological and spinal examinations.