Updated: 10/6/2016


Review Topic
1 1
https://upload.orthobullets.com/topic/2062/images/t2 mri.jpg
  • A fibrous, cartilagenous, or osseous bar creating a longitudinal cleft in the spinal cord
    • if the cord does not reunite distally to the spur, it is considered a diplomyelia (true duplication of the cord)
  • Epidemiology
    • demographics
      • typically presents in childhood
      • adult presentation is rare
    • location
      • more common in lumbar spine (L1 to L3)
  • Pathoanatomy
    • a congenital anomaly believed to be caused by persistence of neuroenteric canal
      • present during 3rd and 4th week of gestation
    • leads to sagittal division of the spinal cord or cauda equina
  • Associated conditions
    • congenital scoliosis
      • as high as 79% in some series
    • tethering of cord
  • Symptoms
    • muscle atrophy
    • weakness
    • bladder or bowel incontinence
  • Physical exam
    • sensory loss
    • reflex asymmetry
    • spinal cutaneous manifestations (>50% of patients)
      • hairy patch (hypertrichosis)
      • dimple
      • subcutaneous mass
      • teratoma
    • lower extremity deformity
      • cavus foot
      • club foot
      • claw toes
  • Prenatal ultrasound
    • may be diagnosed in utero, during the third trimester
  • Radiographs
    • interpedicular widening is suggestive 
  • CT 
    • helpful to delineate bony anatomy  
  • Myelography 
    • spurs are often undetectable by plain radiographs or CT, especially if they are fibrous or there is rotation from concomitant scoliosis
    • myelography is a useful adjuvant
  • MRI
    • required to evaluate degree of neurologic compression 
  • Nonoperative
    • observation alone
      • indications
        • may be observed if patient is asymptomatic and does not have neurologic sequelae
        • must watch closely for progressive neurological deterioration
  • Operative
    • surgical resection
      • indications
        • surgery is indicated if patient is symptomatic or has neurologic deficits
        • must resect diastematomyelia before correction of spine deformity
      • must resect and repair the duplicated dural sac

Please rate topic.

Average 3.8 of 25 Ratings

Thank you for rating! Please vote below and help us build the most advanced adaptive learning platform in medicine

The complexity of this topic is appropriate for?
How important is this topic for board examinations?
How important is this topic for clinical practice?
Topic COMMENTS (6)
Private Note