Proposal for a new clinicoradiological classification of type I split-cord malformations: a prospective study of 25 cases.
METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Gupta
Deepak Kumar
DK
Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
Mahapatra
Ashok Kumar
AK
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D000013:Congenital Abnormalities / Q000145:classification; D004210:Dissection; D005242:Fecal Incontinence / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007870:Leg Length Inequality / Q000150:complications; D008297:Male; D011446:Prospective Studies; D013116:Spinal Cord / Q000002:abnormalities* / Q000601:surgery; D013128:Spinal Osteophytosis / Q000145:classification* / Q000150:complications / Q000601:surgery