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Surgical treatment of a combined split cord malformation and spinal cord lipoma: illustrative case
Michael E Baumgartner1, Thomas A Wozny2, Nima Alan1
1Department of Neurological Surgery, University of California, San Francisco, California.
Insights
Split cord malformations (SCMs) are rare congenital anomalies. Surgical detethering by removing bony spurs, lipomas, and the fatty filum terminale is crucial for symptom relief in adults.
Area of Science:
- Neurosurgery
- Developmental Biology
- Spinal Cord Imaging
Background:
- Split cord malformations (SCMs) are rare congenital anomalies.
- SCMs typically present in childhood but can manifest in adulthood with spinal cord tethering symptoms.
- Associations with lipomas and posterior element defects are uncommon.
Purpose of the Study:
- To report a case of adult-onset SCM with tethering symptoms.
- To describe the surgical management and outcomes.
- To highlight the importance of surgical detethering.
Main Methods:
- A 37-year-old male presented with progressive leg weakness, urinary urgency, and sensory loss.
- MRI revealed a Type I SCM with a dorsal bony defect and intradural lipoma.
- Surgical intervention included laminectomy, bony spur excision, lipoma resection, and filum terminale sectioning.
Main Results:
- The patient experienced new-onset symptoms including leg weakness, urinary urgency, and reduced foot sensation.
- Imaging confirmed a congenital fusion (L2-L4), Type I SCM, and a lipoma.
- Surgical detethering involved removing the bony spur, resecting the lipoma, and sectioning the fatty filum terminale.
Conclusions:
- Effective detethering requires removal of septa, lipomas, and sectioning of the filum terminale.
- Careful lipoma debulking, potentially with a CO2 laser, is essential to minimize tension on the cord.
- Surgical intervention can alleviate symptoms associated with adult-onset SCM.
Background:
Split cord malformations (SCMs) are uncommon congenital anomalies that are usually detected in children, but can present in adulthood with signs and symptoms of spinal cord tethering. SCMs rarely occur in association with a lipoma and a defect in the posterior elements.
Observations:
A 37-year-old man presented with 6 months of new-onset leg weakness, urinary urgency, and reduced sensation in his feet. He developed pain radiating from his low back into his legs, worsened by bending forward and walking. Prior to this presentation, he had not noticed any symptoms. MRI revealed a congenital fusion from L2 to L4 with a type I SCM and a lipoma extending through a dorsal bony defect and terminating at the duplicated spinal cord. A posterior L2-4 lumbar laminectomy was performed to excise the bony spur, resect the spinal cord lipoma, and section the fatty filum terminale.
Lessons:
Removal of the bony or fibrous septum and intradural lipoma and sectioning of the fatty filum terminale are required for effective detethering. Careful lipoma debulking, which can be facilitated with a CO2 laser, must be performed while developing surgical planes and minimizing tension on the tethered cord. https://thejns.org/doi/10.3171/CASE25691.
