IIS IT NECESSARY TO OPERATE ALL SPLIT CORD MALFORMATIONS (SCM) BEFORE LONG SEGMENT CORRECTIVE SURGERY IN PATIENTS WITH CONGENITAL SPINE DEFORMITIES (CSD)?

Abstract

Introduction: After the introduction of MRI in routine diagnostic work-up, Split cord malformations (SCM) in patients with Congenital spinal deformities (CSD) is more easily diagnosed and probably overtreated.

Aim: To evaluate the necessity of neurosurgical management of SCM before corrective spinal surgery.

Study Design: Retrospective case series

Patients and Methods: Thirty-two patients aged 11 years + 8 months (4–18 years) with CSDs with a follow up of 51,7+/−26,6 months were analyzed. SCM were classified as Type I(septum dividing the spinal cord and dura into two separate hemicords) and Type II(two hemicords within single dura) according to Pang. Eighteen patients with type I underwent neurosurgical intervention (spur excision and creating a single dural cuff) before corrective surgery (15 sequential and 3 simultaneous). Fourteen patients with type II were treated with posterior instrumentation without dealing with the intraspinal abnormalities. The basic maneuvers were translation, compression and shortening to realign spinal column, avoiding distraction forces and intrusion of any instrument into the spinal canal around anomalous segments. Neurological monitoring was done by the wake-up test.

Results: At final follow up, scoliosis improved from 65,7+/−22 to 37+/−15 degrees (45%) in type I and from 74,3+/−21,8 to 39,4+/−18,7 degrees (47%) in type II. The correction loss was 2,3 degrees in patients with type I SCM and 2,9 degrees in patients with type II SCM. One patient with type I SCM had paraparesis resulting from a misplaced upper thoracic pedicle screws with total recovery after revision. Another patient with type I SCM who had simultaneous surgeries had deterioration of her preoperative neurological deficit only to recover partially. Two patients with type I SCM and one patient with type II SCM developed deep wound infections and needed multiple debridements. Two patients with type I SCM had dural leakage that needed repair.

Conclusion: Although it is a common practice to operate all SCMs before corrective surgery in CSD, it may not be necessary in type II which can be managed safely without any neurosurgical intervention.