Pediatr Neurosurg. 2002 Mar;36(3):119-27.

Occurrence of split cord malformation in meningomyelocele: complex spina bifida.

Kumar R, Bansal KK, Chhabra DK.

Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical
Sciences, Lucknow, India.

OBJECTIVE: To describe the clinical features and surgical outcome of a combined
anomaly, i.e. split cord malformation (SCM) with meningomyelocele (MMC), and to
propose an addition to Pang's classification of SCM to accommodate a combined
form of anomaly. METHODS: We retrospectively analyzed 16 cases of such a
combination, out of a total of 106 cases of spinal dysraphism treated and studied
prospectively for outcome at our center. The clinical profile and outcome of
these cases are described. RESULTS: All cases had SCM and MMC. Nine patients were
males, and the mean age of presentation was 3.9 years. Twelve patients had Pang's
type I SCM and the other 4 were of type II. The MMC sac was lumbar in 11 cases.
In all the patients, SCM was present either at the same level as the MMC or one
to two segments above it. Nine patients had motor weakness, 6 had hypoesthesia, 4
had urinary incontinence and 3 had trophic ulcers. Nine patients had
neuroorthopedic syndrome. All cases, except 3 (who were operated on at birth, at
which time 'superficial surgery' was performed without relevant imaging),
underwent repair of the MMC and excision of the spur/septum at the same sitting.
The 3 cases who had undergone superficial surgery, however, were operated on for
SCM following investigation at our center, obviously at a second sitting. After
an average follow-up of 7.2 months, 4 patients showed improvement in motor
weakness, 5 in hypoesthesia and 3 in urinary symptoms, whereas trophic ulcers had
healed in all cases. CONCLUSION: With respect to the occurrence of SCM at or
above the level of an MMC, we feel it is apt to screen the entire spinal/neuraxis
by MRI in children with MMC. We labeled this combined pathology 'complex spina
bifida', and feel it is necessary to make a minor modification to Pang's
classification to accommodate the pure/combined anomalies together. Copyright
2002 S. Karger AG, Basel