Diastematomyelia in Kurdistan region of Iraq: A case series analysis of 27 cases reported in Erbil

Emad Kh. Hammood; Injam Ibrahim Rowndzy

doi:10.15218/zjms.2019.016

Authors

Emad Kh. Hammood Department of Surgery, College of Medicine, Hawler Medical University, Erbil, Iraq
Injam Ibrahim Rowndzy Department of Surgery, College of Medicine, Hawler Medical University, Erbil, Iraq

DOI:

https://doi.org/10.15218/zjms.2019.016

Keywords:

Diastematomyelia, Neurological findings, Spinal deformities

Abstract

Background and objective: Globally, diastematomyelia accounts for 5% of all congenital spinal cord defects. Clinically, symptoms of diastematomyelia are non-specific, can be progressive, and can become symptomatic at any age. This study was carried out to describe neurological, radiological and surgical findings of diastematomyelia cases reported in Erbil city of Iraq.

Methods: A retrospective review of diastematomyelia was carried out in three neurosurgical centers in Erbil city of Kurdistan region of Iraq between 1^st January 2003 and 1^st January 2013. Diagnosis of this anomaly was based on CT and MRI with surgical dissection in one case. In patients with contraindication for MRI and CT scan, the diagnosis was based on lumbar myelography. Surgical interventions included surgical decompression and laminectomy with timely follow-up at every six months to assess the outcomes after the surgical intervention.

Results: A total of 27 cases were included in this study with a mean age of 13 years (ranging from 1-19 years) and a female to male ratio of 2.9:1. Spinal deformities (66.7 %) were the main complaints for patients to seek medical advice. Clinically, 89 % of the patients had a huge spinal disfigurement, and 74% had a mid-line thoracic or lumbar cutaneous variation from the norm. Neurologically, 59 % of the patients had a least neurological disability. Radiologically, 96 % showed inter-pedicular separation and spina bifida, 59% scoliosis, and 55.6% boney spicule. Intra-operatively, around 63% of the cases had boney septum separating the dissected hemi-cords; 70 % of the septa located in the lumbar region. Post-operatively, none of the patients experienced decay in their neurologic status after surgery. Over the long term, two patients were slightly improved, and another two had an increased neurological deficit, one patient had better reflexes, but increasing deformity of the foot and 14 patients were unchanged. None of the patients had contamination, pseudoarthrosis, or loss of remedy amid the subsequent visit.

Conclusion: Despite the slight postoperative improvement, all patients with the established preoperative deficit still had residual neurological postoperative deficits and only a low proportion of them slightly improved.

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References

Moradi E, Hanaei S, Shahjouei S, Habibi Z, Nejat F. Trifid cord; very rare presentation of split cord malformation. J Spine 2016; 5:311.

Upasani VV, Ketwaroo PD, Estroff JA, Warf BC, Emans JB, Glotzbecker MP. Prenatal diagnosis and assessment of congenital spinal anomalies: Review for prenatal counseling. World J Orthop 2016; 7(7):406–17.

Sonigo-Cohen P, Schmit P, Zerah M, Chat L, Simon I, Aubry MC, et al. Prenatal diagnosis of diastematomyelia. Childs Nerv Syst 2003; 19(7-8):555–60.

Olaide A, Venkatraman S, Farbod A. Type I split cord malformation: Literature review, case presentation and surgical technique. JSM Neurosurg Spine 2014; 2(3):1026.

Sack AM, Khan TW. Diastematomyelia: Split cord malformation. Anesthesiology 2016; 125(2):397.

Garg K, Mahapatra AK, Tandon V. A rare case of type 1 C split cord malformation with single dural sheath. Asian J Neurosurg 2015; 10(3):226–8.

McShane A, Temponi EF, Millar A. Diastematomyelia- an unusual presentation to rheumatology. Rheumatology (Sunnyvale) 2016; 6(3):204.

Bekki H, Morishita Y, Kawano O, Shiba K, Iwamoto Y. Diastematomyelia: A surgical case with long-term follow-up. Asian Spine J 2015; 9(1):99–102.

Kumar R, Singh S. Spinal dysraphism: trends in northern India. J Neurosurg Pediatr 2003; 38(3):133–45.

Guggisberg D, Hadj-Rabia S, Viney C, Bodemer C, Brunelle F, Zerah M, et al. Skin markers of occult spinal dysraphism in children: a review of 54 cases. Arch Dermatol 2004; 140(9):1109–15.

Kamal HM. Management of type I split cord malformation: Surgical technique and clinical outcome. Med J Cairo Univ 2010; 78(1):247–52.

Russell NA, Benoit BG, Joaquin AJ. Diastematomyelia in adults. Pediatr Neurosurg 1990-91; 16(4-5):252–7.

Anderson FM. Occult spinal dysraphism: a series of 73 cases. Pediatrics 1975; 55(6):826–35.

Cheng B, Li FT, Lin L. Diastematomyelia: A retrospective review of 138 patients. J Bone Joint Surg Br 2012; 94(3):365–72.

Hood RW, Riseborough E, Nehme A, Micheli L, Strand R, Neuhauser E. Diastematomyelia and structural spinal deformities. J Bone Joint Surg Am 1980; 62(4):520–8.

Borkar SA, Mahapatra A. Split cord malformations: A two years experience at AIIMS. Asian J Neurosurg 2012; 7(2):56–60.

Mahapatra A. Split cord malformation: A study of 300 cases at AIIMS 1990–2006. J Pediatr Neurosci 2011; 6(3):41–5.

Gan YC, Sgouros S, Walsh AR, Hockley AD. Diastematomyelia in children: treatment outcome and natural history of associated syringomyelia. Child’s Nerv Syst 2007; 23(5):515–9.