Department of Pediatrics, Juntendo University Faculty of Medicine, 3-1-3 Hongo, Bunkyo, Tokyo 113-8431, Japan.
Department of Neurosurgery, Juntendo University Faculty of Medicine, 3-1-3 Hongo, Bunkyo, Tokyo 113-8431, Japan.
Medicina (Kaunas). 2023 Apr 7;59(4):726. doi: 10.3390/medicina59040726.
The frequency of split cord malformation (SCM) is approximately 1 in 5000 births; however, patients are rarely diagnosed with SCM in the neonatal period. Moreover, there have been no reports of SCM with hypoplasia of the lower extremities at birth. A 3-day-old girl was transferred to our hospital for a thorough examination of hypoplasia of the left lower extremity and lumbosacral abnormalities detected after birth. The spinal magnetic resonance imaging (MRI) revealed a split spinal cord in a single dural tube. Based on the MRI findings, the patient was diagnosed with SCM type II. Following discussions with the parents, pediatricians, neurosurgeons, psychologists, and social workers, we decided to perform untethering to prevent further neurological impairment after achieving a sufficient body weight. The patient was discharged on day 25 of life. Early diagnosis and intervention may improve the neurological prognosis in terms of motor function, bladder and bowel function, and superficial sensation; thus, clinicians should report infrequent findings that may lead to SCM diagnosis. SCM should be differentiated in patients with left-right differences in the appearance of the lower extremity, particularly in those with lumbosacral abnormalities.
脊髓纵裂畸形(SCM)的发病率约为每 5000 例出生婴儿中有 1 例;然而,新生儿期很少诊断出 SCM。此外,出生时下肢发育不全的 SCM 尚未见报道。一名 3 天大的女婴因出生后发现左下肢发育不全和腰骶部异常被转至我院接受全面检查。脊髓磁共振成像(MRI)显示单一硬脊膜管内脊髓分裂。根据 MRI 结果,患者被诊断为 SCM Ⅱ型。在与家长、儿科医生、神经外科医生、心理学家和社会工作者进行讨论后,我们决定在体重达到足够水平后进行松解术,以防止进一步的神经损伤。患儿于出生后第 25 天出院。早期诊断和干预可能会改善运动功能、膀胱和肠道功能以及浅感觉方面的神经预后;因此,临床医生应该报告可能导致 SCM 诊断的罕见发现。对于下肢左右外观存在差异的患者,特别是存在腰骶部异常的患者,应鉴别 SCM。