Diastematomyelia - a diagnostic and therapeutic problem. Case study.

BACKGROUND

Diastematomyelia is a type of dysraphism with a double or bifid spinal cord divided by an osseous septum. This defect often co-occurs with other developmental disorders of the skull or the atlanto-occipital junction. The course may be benign or aggressive. 2.

CASE REPORTS

We describe two female patients treated in the Rehabilitation Clinic and the Orthopaedic Department at the Medical University of Lublin in the years 2004 - 2009. The first patient was diagnosed at the age of 20 years to have diastematomyelia at the L3 level and spina bifida occulta at L1- S5 and at the C1 arch. In the other patient, diastematomyelia at the L3 level and spondylolisthesis at L5-S1 were found at the age of 14 years. Initially both patients were treated for lumbosacral radicular syndromes. Physiotherapy intensified the pain. The patient with diastematomyelia and L5-S1 spondylolisthesis had L5-S1 segment stabilization performed at the age of 16. The pain subsided after the surgery. The other patient was instructed to stop rehabilitation, follow a balanced lifestyle, and refrain from physical work, which eliminated the pain.

DISCUSSION

Managing a patient with diastematomyelia demands caution. Diagnosis of this defect requires a thorough cause-and-effect analysis of the presenting signs and symptoms of spinal dysfunction. The treatment should be dependent on local pain intensity (which is often not directly associated with the disorder) and on the degree of neurological dysfunction. 5.

CONCLUSIONS

1. A thorough clinical evaluation with spinal imaging prior to elective surgery for scoliosis and other spine deformities should be a standard procedure undertaken in order to avoid complications. 2. The treatment for diastematomyelia should depend on the intensity of local pain and on the level of neurological dysfunction. 3. Broadly understood rehabilitation is not always effective, often increasing the pain and/or neurological complaints.