Gupta Deepak Kumar, Mahapatra Ashok Kumar
Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
Pediatr Neurosurg. 2006;42(6):341-6. doi: 10.1159/000095563.
Split-cord malformations (SCMs) are rare malformations of the spinal cord. A new classification is proposed based on intraoperative findings in 25 cases of type I SCMs (with bony spur). Patients' demographic profile, radiological and surgical details, complications and outcome were noted.
All patients had type I SCMs. The mean age of the patients was 6.2 years (female:male ratio 1.2:1). Asymmetric lower-limb and sphincter weakness were present in 17/25 (68%) and 5/25 (20%) cases, respectively. Of the symptomatic cases, 29.4% (5/17) showed improvement in motor power and sensory improvement was recorded in 33.3% (4/12) of patients while 40% (2/5) regained continence. No patient in the asymptomatic group (0/8) showed postoperative neurological deterioration. A new subclassification of type I SCM is proposed based on the location of the bony spur responsible for the split, which can affect surgical dissection and outcome.
In SCM patients, the risk of developing neurological deficits increases with age, hence all SCM patients should undergo prophylactic surgery, even if they are asymptomatic. Our new classification is easy to use and takes into account intraoperative findings that may affect surgical outcome.
脊髓纵裂畸形（SCMs）是一种罕见的脊髓畸形。基于25例I型SCMs（伴有骨嵴）的术中发现提出了一种新的分类方法。记录了患者的人口统计学资料、影像学和手术细节、并发症及预后情况。
所有患者均为I型SCMs。患者的平均年龄为6.2岁（女性与男性比例为1.2:1）。17/25（68%）的病例存在不对称下肢无力，5/25（20%）的病例存在括约肌无力。在有症状的病例中，29.4%（5/17）的患者运动能力有所改善，33.3%（4/12）的患者感觉有所改善，40%（2/5）的患者恢复了控尿功能。无症状组患者（0/8）术后均未出现神经功能恶化。根据导致脊髓纵裂的骨嵴位置提出了I型SCM的一种新的亚分类方法，该位置可能影响手术分离及预后。
在SCM患者中，出现神经功能缺损的风险随年龄增长而增加，因此所有SCM患者均应接受预防性手术，即使他们无症状。我们的新分类方法易于使用，并考虑到了可能影响手术预后的术中发现。
