PMC9491464_01
Preoperative MRI. The spinal cord was shifted down, approximately at L4 segment, with bifurcation of the lower part. The lamina of L3 segment was not fused, and the spinous process protruded into the spinal canal, resulting in spinal stenosis of the related segments.
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F1
There was neither obvious abnormality in the lumbar intervertebral disc, nor was there any thickening of the ligamentum flavum (Figure 1).
Preoperative physical examination of the lower limbs. The patient showed clubfoot of the right lower limb,while the normal of the other.
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F2
The patient suffered clubfoot of the right lower limb (Figure 2), but no abnormality in the left lower limb, negative findings in the Bragard sign of both lower limbs, and normal blood supply of both lower limbs.
Preoperative digital radiography. Spina bifida is shown in the lumbar spine, with the L3 spinous process extending into the spinal canal.
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F3
Digital radiography indicated spina bifida, with the L3 spinous process protruding into the spinal canal (Figure 3).
Preoperative CT. The lamina of the L3-5 vertebra were not fused, the spinous process of the L3 protrudes inward, considerating diastematorrhachia.
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F4
Computed tomography (CT) indicated lamina infusion of the L3-5 segments, with inward protrusion of the L3 spinous process into the spinal canal and local spinal stenosis, indicating a congenital diastematorrhachia (Figure 4).
Preoperative enhanced MRI. The spine was diastematomyelia, with tethered spinal cord and terminal filament lipoma, infusion of the lamina at L3-5 segments, and local lamina thinning.
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F5
Enhanced MRI showed diastematomyelia, with tethered spinal cord and terminal filament lipoma, infusion of the lamina at L3-5 segments, and local lamina thinning, suggesting spina bifida (Figure 5).
Ultrasound examination of the right armpit. An accessory breast was in the right armpit, at about 0.67  x  0.49  x  0.28 cm3.
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F6
Ultrasound examination revealed an accessory breast in the right armpit, accompanied by sheet-like hypoechoic sound, about 0.67 x 0.49 x 0.28 cm3 (Figure 6).
Postoperative digital radiography. The spine was bifida, with no display of some lumbar spinous processes.
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F7
Digital radiography indicated spina bifida, with no display of some spinous processes of the lumbar spine (Figure 7).
Postoperative CT. The spur was excised and the laminae of the L3-5 segments were not fused.
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F8
CT showed that the soft tissues of the L3 segment were swollen, but the laminae of the L3-5 segments were not fused (Figure 8).
Postoperative MRI. The compression of the spinal cord was removed, with diastematomyelia and tethered cord, without fusion of the L4-5 vertebral arches.
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F9
The MRI indicated diastematomyelia and tethered cord with no fusion of the L4-5 vertebral arches (Figure 9).