Split Cord Malformation as aCause of Tethered Cord Syndrome in a 78-Year-Old Female

Abstract

A 78-year-old woman presented for evaluation of back pain, urinary dysfunction, leg weakness and progressive equinovarus foot deformity. She reported that shortly after her birth in 1924, she underwent resection of a subcutaneous ‘cyst’ in the lower lumbar area. Seven years prior to evaluation at our institution, she had undergone bilateral total knee arthroplasty for osteoarthritis. After the procedure, she began to experience severe low back pain that radiated into her legs. Weakness of the foot inverters, urinary dysfunction and worsening bilateral equinovarus foot deformity developed in the years following the surgery. MRI revealed a split cord malformation with a tethered spinal cord. Because of the patient’s age and poor medical condition, her symptoms were managed conservatively. This case demonstrates symptomatic deterioration in an elderly patient with a tethered spinal cord after many years of clinical stability.

Split cord malformation associated with scoliosis in adults

“…In type II SCM, the hemicords are encased within a single dural sac and the median structure is composed of nonrigid fibrous tissues. 2,18 Our cases do not fit nicely into this classification system because both patients had hemicords separated by a bony spicule and were contained within a single dural sac. A peculiar detail of our cases was the orientation between the anatomic location of the bony spicule and the level of SCM hemicord split.…”

Type I split cord malformation and tethered cord syndrome in an adult patient: A case report and literature review

“…In adulthood, presentation differs somewhat, with predominance of back and leg pain rather than with overt skeletal abnormalities or with progressive urological or orthopedic dysfunction. [12,15,26,32,34] Our patient presented primarily due to back and leg pain. In literature, 76% of patients present with back pain and 72% with leg pain.…”

“…[16,17,19,21,26,27,31] Two subsets of patients with SCM present in adulthood – those with SCM diagnosed in childhood who experience recrudescent symptoms and those who are first diagnosed with SCM in adulthood. [26] Our patient falls into this second category. In adulthood, presentation differs somewhat, with predominance of back and leg pain rather than with overt skeletal abnormalities or with progressive urological or orthopedic dysfunction.…”

Split Cord Malformation Combined with Tethered Cord Syndrome in an Adult

“…This malformation has been reported to be associated with a split of the spinal column, spinal bony spurs, myeloceles, myelomeningoceles, lipomas, and dermal sinus15,16).…”