Management of split cord malformation in children: the Lyon experience
Split cord malformation (SCM) is a rare congenital spinal abnormality. Clinical presentation varies. Other congenital defects can be associated. Management is surgical.
Material and methods
We retrospectively reviewed all our SCM cases and reported our experience for its management. From 1990 to 2014, 37 patients were operated. Five situations lead to the diagnosis (orthopedic disorders (n = 8), orthopedic and neurological disorders (n = 16), pure neurological disorders (n = 5), no symptoms except cutaneous signs (n = 7), antenatal diagnosis (n = 1)). Scoliosis was the most common associated condition. The level of the spur was always under T7 except in one case. There were more type I (n = 22) than type II (n = 15) SCM.
Patients with preoperative neurological symptoms (n = 21) were improved in 71.4%. Five out of nine patients that had preoperative bladder dysfunction were improved. Eleven patients needed surgical correction of the scoliosis.
For us, the surgical procedure is mandatory even in case of asymptomatic discovery in order to avoid late clinical deterioration. In any case, the filum terminale need to be cut in order to untether completely the spinal cord. In case a surgical correction of a spinal deformity is needed, we recommend a two-stage surgery, for both SCM type. The SCM surgery can stop the evolution of the scoliosis and it may just need an orthopedic treatment with a brace.
KeywordsDiastematomyelia Diplomyelia Split cord malformation Surgery Tethered cord syndrome Bone spur
Cerebro spinal fluid
- CT scan
computed tomography scanner
Magnetic resonance imaging
Split cord malformation
Compliance with ethical standards
Conflict of interest
The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors
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