This is a letter to share the clinical experience we had with neonates born with a specific feature of spina bifida. The lesion is like a meningocele containing skim amount of fluid, with a tiny dimple around the center of the cutaneous lesion which causes inward retraction of the dysplastic coverage. This feature is in favor of accompanied split cord malformation (SCM) type I, and the central nidus is in continuous with the dural sleeve around the bony septum of SCM. By recognition of this clinical clue, surgical repair can be planned to perform with appropriate provision, particularly foreseeing the amount of intraoperative bleeding and duration of anesthesia in the newborn patients.

Variations in split cord malformation (SCM) are known. However, association of SCM type I with myelomeningocele along with same level dorsal bony spur has not been described previously. We report a 1-year old male child who presented with these findings with associated syringomyelia, lipoma and tethered cord.

Case series, literature review, and technical note. To compare two different approaches to treat the spinal deformity with split cord malformation type I (SCM I). To present a new method of one-stage surgical treatment of congenital spinal deformity with wide bony septum (SCM I). Analysis of the literature on the different types of combined surgical treatment of spinal deformities with SCM I was performed. We have provided our own data on 27 patients treated for congenital spinal deformity and SCM I, one of which underwent Schwab IV type osteotomy at the apex of the deformity through the bony septum and pedicles. Inclusion criteria were presence of spinal deformity in combination with SCM 1, performed surgery to correct spinal deformity, and follow-up period of at least 2 years. The result of the literature review was controversial and requires additional research. The average age of patients was 8.8 ± 6.6 years old. One-stage treatment of SCM I and spinal deformity was performed in 10 patients (group I) and two-stage in 14 patients (group II). Three patients with severe myelodysplasia, SCM I, and congenital kyphoscoliosis underwent correction of spinal deformity without SCM I removing (group III). The group I had the longest surgery duration (mean 289 ± 75 min) and largest blood loss (mean 560 ± 386 ml), a high percentage of deformity correction (mean 69.6%), and the highest rate of complications (60%). The most optimal was the two-stage treatment with the mean surgery duration 191 ± 137 min, mean blood loss 339 ± 436 ml, mean correction rate 63%, and frequency of complications 21%. The average follow-up time was 6.0 ± 2.6 years. One stage surgery associated with a large surgical invasion and a large number of complications. It can be used in some cases, for example when the wide bony septum (SCM I) is localized at the apex of the congenital scoliosis or kyphosis. In all other cases, it is worth adhering to a two-stage treatment. Many new works demonstrate the relative safety and effectiveness of deformity correction without removing the SCM. In our opinion, indications for treatment of spinal deformity without SCM I removing can be the need to perform a shortening ostetomy outside the SCM zone. The remaining cases require a thorough assessment and a balanced decision.

A 2-year-old male neutered mixed breed dog with a body weight of 30 kg was presented for evaluation of a soft subcutaneous mass on the dorsal midline at the level of the caudal thoracic spine. A further clinical sign was intermittent pain on palpation of the area of the subcutaneous mass. The owner also described a prolonged phase of urination with repeated interruption and re-initiation of voiding. The findings of the neurological examination were consistent with a lesion localization between the 3rd thoracic and 3rd lumbar spinal cord segments. Magnetic resonance imaging revealed a spina bifida with a lipomeningocele and diplomyelia (split cord malformation type I) at the level of thoracic vertebra 11 and 12 and secondary syringomyelia above the aforementioned defects in the caudal thoracic spinal cord. Surgical resection of the lipomeningocele via a hemilaminectomy was performed. After initial deterioration of the neurological status postsurgery with paraplegia and absent deep pain sensation the dog improved within 2 weeks to non-ambulatory paraparesis with voluntary urination. Six weeks postoperatively the dog was ambulatory, according to the owner. Two years after surgery the owner recorded that the dog showed a normal gait, a normal urination and no pain. Histopathological diagnosis of the biopsied material revealed a lipomeningocele which confirmed the radiological diagnosis. Ein 2-jähriger Mischlingsrüde mit einem Körpergewicht von 30 kg wurde aufgrund einer dorsalen subkutanen Masse im Bereich der kaudalen Brustwirbelsäule vorgestellt. Ein weiteres klinisches Symptom war eine intermittierende Schmerzhaftigkeit bei Palpation im Bereich dieser Masse. Der Besitzer beschrieb zudem eine verlängerte Phase des Urinabsatzes mit wiederholter Unterbrechung und Wiederaufnahme der Miktion. Die Befunde der neurologischen Untersuchung entsprachen der Lokalisation der Rückenmarksabschnitte zwischen dem 3. Brust- und 3. Lendenwirbel. Die magnetresonanztomographische Untersuchung zeigte eine Spina bifida mit einer Lipomeningozele und Diplomyelie (Split-Cord-Malformation Typ I) auf Höhe des 11. und 12. Brustwirbels und eine sekundäre Syringomyelie kranial des besagten Defekts im Bereich der kaudalen Brustwirbelsäule. Es wurde eine chirurgische Resektion der Lipomeningozele mittels Hemilaminektomie vorgenommen. Nach anfänglicher postoperativer Verschlechterung des neurologischen Zustands mit Paraplegie und fehlender Tiefenschmerzwahrnehmung kam es innerhalb von 2 Wochen zu einer Verbesserung. Der Hund wies eine nicht gehfähige Paraparese auf und konnte selbstständig Urin absetzen. Nach Aussage des Besitzers war der Hund 6 Wochen postoperativ gehfähig. Zwei Jahre nach der Operation berichtete der Besitzer, der Hund zeige einen normalen Gang, einen unauffälligen Urinabsatz und keine Anzeichen für Schmerzen. Die histopathologische Untersuchung bestätigte die radiologische Diagnose einer Lipomeningozele.

Lipomyelomeningocele (LMMC) is defined by a low-lying tethered spinal cord protruding posteriorly from the spinal canal and terminating in a lipomatous mass in the subcutaneous meningeal sac. The coexistence of LMMC with split cord malformation (SCM) is rare. We report on a patient with laterally protruded LMMC arising from the hemicord of SCM type I. Direct coronal and axial views (instead of sagittal views) of 3D heavily T2-weighted MR imaging (3D-hT2WI) clearly demonstrated the topographical relationship between both of the hemicords, the bony septum, and nerve roots in the right subcutaneous meningeal sac. Combined use of axial and coronal images of 3D-hT2W is useful for visualization and surgery of such a complicated anomaly.