Management of split cord malformations associated with other deformities in children / 中国矫形外科杂志

ABSTRACT

[Objective]To analyze clinical features,evaluate diagnostic procedures and discuss the different forms of therapy for each case of split cord malformation(SCM).[Method]A series of 48 patients had a follow-up period of 0.5~9 years,29 males and 19 females,aged 7 days to 14 years,were evaluated retrospectively.They suffered from back midline abnormalities,neurological deficits of lower limbs and bladder dysfunction.At first they were cut filum terminale and then excised the fibrous or bony spur finally treated scoliosis.The radiologieal procedures used for the diagnosis of SCM were spinal X-ray,ultrasound,CT scan and MRI.[Result]In all of the 48 patients with tethered cord,there were 28 cases with dysplasia of lower limbs and feet,13 cases with urination and defecation dysfunction,14 cases with only dorsal-lumbar abnormalities,26 cases with scoliosis and kyphosis,14 with myelomeningocele,15 with syringomyelia and 12 with intraspinal lipomas.There were 27 cases suffering from type Ⅰ SCM,18 type Ⅱ SCM and 3 composite type SCM according to Pang.The most frequent location of the spur was at the lumbar level(38 cases),the less frequent in thoracic regions(6 cases)and exceptionally rare below S_1(2 cases),in the cervical regions(1 case),the thoralumbar(1 case).After operation,28 cases were improved,3 cases were cured and 3 cases were inefficacy.[Conclusion]The most frequent syndrome of SCM patients is lower limbs dysplasia and dorsal-lumbar abnormalities.The patients are most suffered from tethered cord and spinal deformities.To improve diagnosis of SCM,tethered cord and other deformities,the patients should be routinely evaluated by MRI and X-ray of the whole spine,sometimes could be evaluated by ultrasound and CT scan.SCM cases should be early treated by first cutting filium terminal and then excising fibrous or bony spur and hemivertebra.