PMC7656001_01
X-ray dorsolumbar spine showing severe kyphoscoliotic deformity.
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F1
Her radiology revealed kyphoscoliotic deformity with segmentation anomalies including hemivertebrae and bifid spine at multiple levels, low lying tethered spinal cord (up to the upper sacral level) with diastematomyelia [Type 1 Split cord malformation (SCM) with 2 dural tubes] with a bony spur at D12/L1 level with triplomyelia at D10 level (3 hemicords within a single dural tube) and small lipomyelomeningocele attached to the right hemicord at L4/L5 level [Figures 1-4].
Computed tomography dorsolumbar spine revealed (a) segmentation anomalies including hemivertebrae and bifid spine at multiple levels and (b) bony spur dividing the spinal canal into two asymmetrical halves at D12/L1 level.
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F2
Her radiology revealed kyphoscoliotic deformity with segmentation anomalies including hemivertebrae and bifid spine at multiple levels, low lying tethered spinal cord (up to the upper sacral level) with diastematomyelia [Type 1 Split cord malformation (SCM) with 2 dural tubes] with a bony spur at D12/L1 level with triplomyelia at D10 level (3 hemicords within a single dural tube) and small lipomyelomeningocele attached to the right hemicord at L4/L5 level [Figures 1-4].
Axial magnetic resonance imaging dorsolumbar spine image at D10 level showing triplication of the spinal cord (triplomyelia).
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F3
Her radiology revealed kyphoscoliotic deformity with segmentation anomalies including hemivertebrae and bifid spine at multiple levels, low lying tethered spinal cord (up to the upper sacral level) with diastematomyelia [Type 1 Split cord malformation (SCM) with 2 dural tubes] with a bony spur at D12/L1 level with triplomyelia at D10 level (3 hemicords within a single dural tube) and small lipomyelomeningocele attached to the right hemicord at L4/L5 level [Figures 1-4].
Intraoperative photographs showing (a) diastematomyelia with two dural tubes (arrows), with a rigid bony septum in between (black arrowhead). (b) At D10 level, there was triplication of the spinal cord (arrows). The thicker left hemicord split again to form two smaller hemicords. Above and below this level, the left hemicord continued as one. (c) Lipomyelomeningocele attached to the right hemicord at L4/L5 level (arrow) (d) reconstitution of the dural tube into one at the end of the procedure.
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F4
Her radiology revealed kyphoscoliotic deformity with segmentation anomalies including hemivertebrae and bifid spine at multiple levels, low lying tethered spinal cord (up to the upper sacral level) with diastematomyelia [Type 1 Split cord malformation (SCM) with 2 dural tubes] with a bony spur at D12/L1 level with triplomyelia at D10 level (3 hemicords within a single dural tube) and small lipomyelomeningocele attached to the right hemicord at L4/L5 level [Figures 1-4]. At surgery, D10 to S1 laminectomy, excision of the dural sheathed bony spur with attached dura, detethering of cord (intraoperative neurophysiological monitoring through direct nerve root stimulation technique was used during detethering to avoid inadvertent injury to important nerves) with the reconstitution of the dural tube into one was done [Figure 4]. Intraoperatively, triplication of the spinal cord (triplomyelia) was seen [Figure 4b]. At D12/L1 level, the spinal cord split into two asymmetrical halves with separate dural coverings [Figure 4a]. Above and below this level, the left hemicord continued as one [Figure 4b].