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. 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. 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.

To describe prenatal imaging findings and postnatal outcomes in fetuses diagnosed with saccular forms of closed spinal dysraphism (CSD). This retrospective single-centre study included fetuses diagnosed with non-genetic, non-syndromic CSD between January 2018 and June 2023. Prenatal ultrasound and MRI findings were reviewed, with postnatal outcomes assessed in those managed expectantly, focusing on neurosurgical interventions, motor function, and urologic and bowel outcomes. Eighteen cases were identified; twelve opted for expectant management and had postnatal follow-up. The most common lesion was dysraphic spinal cord lipoma (10/18, 55.6%), followed by limited dorsal myeloschisis (3/18, 16.7%), myelocystocele (3/18, 16.7%) and meningocele (2/18, 11.0%). Chiari malformation and related brain abnormalities were absent at the time of diagnosis in all cases. Most fetuses (88.9%, 16/18) had a low-lying conus medullaris, and 70.6% (12/17) had a sac wall thickness ≥ 2 mm. Postnatally, 75% (9/12) underwent surgical detethering. At ≥ 30 months, all children could walk independently with or without orthoses. However, urologic complications were common in children age ≥ 48 months: 80% (4/5) required clean intermittent catheterization (CIC), 60% (3/5) had urinary incontinence, and 40% (2/5) experienced bowel incontinence. Prenatal imaging features at the lesion level are key for diagnosing CSD. While motor outcomes are favorable, urologic and bowel dysfunctions are frequent in postnatal life.

Extradural spinal tumors represent a large proportion of all spinal tumors and commonly present with spinal cord or nerve root compression. Although metastatic lesions are the most frequent, benign and less common entities may also occur. Prompt recognition is essential to prevent irreversible neurological compromise. We report the case of a 55-year-old male patient with diabetes mellitus who presented with paraplegia following three months of progressive dorsal pain and lower limb paresthesias. Neurological examination revealed flaccid paralysis of the lower limbs, sensory loss below the T5 dermatome, and sphincter dysfunction. Thoracic spine MRI demonstrated a posterior extradural mass extending from T3 to T6, compressing the spinal cord and associated with hematomyelia. The patient underwent urgent posterior decompression with wide laminectomy, complete tumor resection, and instrumented stabilization using transpedicular screws and titanium rods. Vancomycin powder was applied intraoperatively for infection prophylaxis. Postoperatively, the patient regained superficial sensation in the lower limbs and sphincter control within two months. At six months, neurological function improved to American Spinal Injury Association (ASIA) grade C, with muscle strength graded 3/5 at the hips and knees and 2/5 at the ankles according to the Medical Research Council (MRC) scale, allowing assisted ambulation through intensive physiotherapy. Histopathological examination confirmed a fibrolipoma with secondary ischemic and inflammatory changes and partial bone necrosis, without evidence of malignancy. Reporting such cases contributes to the understanding of the clinical spectrum of extradural spinal tumors and reinforces the need for prompt recognition and intervention.

Spinal dysraphism consists a group of congenital anomalies due to defective neural tube closure, among which diastematomyelia or split cord malformation is rare. Split cord malformation is classified into Type I and Type II, with Type II being less common and often asymptomatic. These anomalies may coexist with various spinal anomalies, as tethered cord, neural lipoma, hemimyelocele, and dorsal dermal sinus, forming a complex spectrum. Adult presentations are particularly uncommon and usually incidental. We herein report a 23-year-old male with chronic low back pain and a congenital midline lumbar swelling. Neurological examination and routine investigations were unremarkable. Magnetic resonance imaging revealed Type II diastematomyelia with two hemicords within a single dural sac from L4 to L5, low-lying conus medullaris, hemimyelocele with neural lipoma at L5-S1, tethered cord with filum terminale lipoma extending to S3-S4, and a dorsal dermal sinus tract. Despite the radiological complexity, the patient remained neurologically intact. Neurosurgical intervention was advised; however, the patient chose conservative management with close follow-up. This case highlights a rare adult presentation of complex spinal dysraphism with minimal symptoms. While diastematomyelia Type II is typically diagnosed in childhood, adult cases are infrequent and often delayed. Magnetic resonance imaging is crucial for diagnosis, particularly in asymptomatic individuals with cutaneous markers. Though surgery is generally recommended to prevent neurological decline, conservative management may be appropriate in selected stable cases. This case emphasizes the need to consider spinal anomalies in adults with chronic back pain and the importance of multidisciplinary evaluation.

The rate of dorsal column deficit after intramedullary spine tumor resection remains unknown. In a cohort of patients undergoing posterior intramedullary spinal tumor resection, the authors sought to 1) report the rate of dorsal column deficits, 2) report the rate of new motor deficits, and 3) determine risk factors and recovery characteristics for both deficits. A single-institution, retrospective cohort study of patients undergoing posterior intramedullary spinal cord tumor resection was performed from 2010 to 2020. Primary and metastatic cord tumors were included; cauda equina tumors and patients not undergoing midline myelotomy were excluded. Exposure variables included posterior midline myelotomy, tumor location within the spinal cord, spinal segment, tumor size, presence of cord edema on preoperative imaging, and complete/partial resection. The primary outcome was dorsal column deficit (new numbness/tingling, diminished fine touch, vibration, or 2-point discrimination, or balance/proprioceptive problems). Descriptive statistics were performed. Of 34 patients undergoing intramedullary tumor resection, the mean ± SD age was 44.4 ± 12.1 years and 55.9% were male. Histological analysis showed that 22 (64.7%) patients had ependymoma, 3 (8.8%) astrocytoma, 2 (5.9%) glioblastoma, 2 (5.9%) low-grade glioma, 2 (5.9%) lung adenocarcinoma, and 1 (2.9%) each of hemangioblastoma, lipoma, and necrosis possible neoplasm. Tumor locations were cervical in 17 (50.0%) patients, thoracic in 15 (44.1%), and thoracolumbar/conus in 2 (5.9%). Complete resection was achieved in 19 (55.9%) patients. At presentation, 26 (76.5%) patients had dorsal column deficits and 17 (50%) had motor deficits. Deficits worsened in 17/26 patients with preoperative motor deficits, remained the same in 9, and improved in 0. In 8 patients without preoperative dorsal column deficits, 7 had new dorsal column deficit and 1 had none. A postoperative dorsal column deficit was seen in 33/34 (97%) patients. At the most recent follow-up, 6/33 (18%) patients had improvement in dorsal column deficits and 27/33 (82%) had stable deficits. Postoperative dorsal column deficits occurred in 97% patients who underwent midline myelotomy for intramedullary tumor resection. Dorsal column deficits improved in 18% yet remained stable in the remaining 82%. Motor deficits improved in only 12% and remained stable/worsened in 88%. These results highlight the high rate of dorsal column deficits in patients requiring midline myelotomy for resection of intramedullary tumors.