Indian J Pediatr. 2005 Feb;72(2):109-15.

Comparative study of complex spina bifida and split cord malformation.

Kumar R, Singh SN, Bansal KK, Singh V.

Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical
Sciences & King Georges Medical University, Lucknow, India.

OBJECTIVE: To see the difference in clinical profiles, radiological findings and
surgical outcome of the group 1 split cord malformation and meningomyelocele (SCM
with MMC) from group 2 (SCM without MMC). METHODS: 46 patients of SCM were
selected from a total of 138 cases of spinal dysraphism. They were divided into
two groups, based on presence or absence of MMC. Group I (SCM with MMC) n =19
patients and Group II (SCM without MMC) n=27 patients. A detail clinical
evaluation and MR screening of whole spine of all cases was performed. All
patients underwent surgical detethering of cord. After an average follow-up of
1.7 years, the operative results were clinically assessed and statistical
significance was calculated. RESULTS: Male to female ratio was 1:09. Mean age of
presentation was 3.6 years. Cutaneous markers like tuft of hair, cutaneous
haemangioma, etc, had a higher incidence in group II in comparison to group I
(50% vs 10.5%). The incidence of motor deficits was significant in group I in
comparison to group II (63% vs 40%). The incidences of sensory loss, trophic
ulcers, sphincteric dysfunction and muscle atrophy were relatively more common in
group I patients, while neuro-orthopedic deformities such as congenital telepes
equinovarus (CTEV), scoliosis and limb shortening were more frequent (67%) in
group II children as compared to group I (53%). Type I SCM has higher incidence
in group I children. Low lying conus were found in 47% patient of group I, while
in group II it was noticed in 69%. The associated cranial anomalies like
hydrocephalus, ACM and syrinx, were slightly higher in group I patients. At
surgery, dysgenetic nerve roots, neural placode, arachnoid bands and atrophic
cord were seen mainly in group I. Postoperative complications like, CSF leak,
pseudomeningocele and meningitis were more commonly encountered in group I
patients. The patients of group II showed better operative outcome compared to
group I cases. CONCLUSION: Incidence of SCM with MMC amount to 41% of total SCM
cases. Progressive neurological deficit was higher in this group (SCM with MMC)
in comparison to the group harboring SCM without MMC. In view of a significant
association of SCM in MMC cases, associated with other craniospinal anomalies, a
thorough screening of neuraxis (by MRI) is recommended to treat all treatable
anomalies simultaneously for desired outcome.