Diastematomyelia--clinical manifestation and treatment outcome

Diastematomyelia is a rare congenital anomaly characterized by a division of the spinal cord or the filum terminale into two parts. In Korea, only one case has been reported. The authors have operated on 5 cases of diastematomyelia with septum since July, 1978. The ages ranged from 1 to 44 years (median; 11 years). There were 2 boys, 2 girls and an adult man. The disease manifested by cutaneous abnormalities and neurological or orthopedic deficits. Pain was a chief complaint in the adult patient. The symptoms had progressed in 3 cases. The diagnosis was made correctly by CT myelography or MRI in 4 cases. The median septum was located at the lumbar area in 4 cases and at the lumbosacral region in 1 case. Associated abnormalities included low lying conus (5 cases), lipoma (2 cases), thickened filum terminale (1 case), hemilipomyelomeningocele (1 case) and syrinx (1 case). The median septum was removed. The dural sleeve adjoining the septum was resected and the dural sac was reconstructed. The role of MRI in the diagnosis and planning of surgery and the high frequency of associated low lying conus were emphasized. Though the surgical treatment relieved pain, it did not reverse the neurological deficits or orthopedic deformities significantly, which suggests the beneficial effects of early surgical intervention in the cases with progressive symptoms.