PMC4854038_01
T1-weighted image (sagittal section) with the dermal sinus tract (pointed by the blue arrow)
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F1
Examination of the back revealed a very small, abnormal tuft of hair in the midline in the mid lumbar region suggesting the presence of occult spinal dysraphism [Figure 1]. T4 to T6, separated by a bony spur. The two hemicords then entered the same dural sheath but before uniting into a single, normal spinal cord, divided into another Type 1 SCM from T9 to T11, separated by another bony spur. The two hemicords then fused into a single dural sheath before continuing as a single spinal cord from T12 onward [Figure 2]. The MRI also showed a DST at L1 [Figure 1] and an epidural abscess from T12 to L3 level [Figure 3].
This sequence (axial section) shows the spinal cord as seen at T6, T11, and T12, respectively
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F2
T4 to T6, separated by a bony spur. The two hemicords then entered the same dural sheath but before uniting into a single, normal spinal cord, divided into another Type 1 SCM from T9 to T11, separated by another bony spur. The two hemicords then fused into a single dural sheath before continuing as a single spinal cord from T12 onward [Figure 2]. The MRI also showed a DST at L1 [Figure 1] and an epidural abscess from T12 to L3 level [Figure 3].
T2-weighted image (sagittal section) showed the presence of abscesses
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F3
T4 to T6, separated by a bony spur. The two hemicords then entered the same dural sheath but before uniting into a single, normal spinal cord, divided into another Type 1 SCM from T9 to T11, separated by another bony spur. The two hemicords then fused into a single dural sheath before continuing as a single spinal cord from T12 onward [Figure 2]. The MRI also showed a DST at L1 [Figure 1] and an epidural abscess from T12 to L3 level [Figure 3].
The dermal sinus tracts as seen intraoperatively (labeled by the blue arrow) leading to thecal sac and epidural abscess
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F4
Upon dissecting the lumbar fascia, a thick-walled, pearly white, elongated sinus tract was soon visible [Figure 4].