This case don't needed further description. I pressume that is very clear that there are 2 parallel lumbar vertebraes semideveloped, each one with its own pedicle, vertebral body and laminae.
Patient had a visible, ulcerated open spine defect. CT is great for evaluation of bone structures but we need MRI to clearly define this pathology because it can clearly show the spinal chord and conus medularis, dural sac and meninges. This case was unknown to me, at first I thought maybe it is a severe form of diastematomyelia (two hemichords?). One thing is a fact, that there is a duplication of almost 3 lumbar vertebraes and latter fusion at sacrum level. This remarcable defect is rare and exceptional.
It i typically associated with severe neurologic abnormalities (dicephalus, myelomeningocele) or gastrointestinal abnormalities (omphalocele, neurenteric fistulas).
The pathologic variants of split cord malformation range from a fibrous septum only partially splitting the cord and acting as a tether point within a single dural sac, at the mild end of the spectrum to gross vertebral anomalies with partial spine duplication and tethering at a fibro-osseous midline mass often associated with a lipomeningomyelocele or neurenteric cyst at the severe end.
For further information please reffer to links below.
Thank you all COBRAns for your participation on FB group.
- http://link.springer.com/content/pdf/10.1007%2FPL00007301
- http://www.ajnr.org/content/25/5/895.full.pdf+html
- http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2647508/pdf/i1079-0268-32-1-99.pdf
- http://www.ajnr.org/content/25/5/895.full.pdf
- http://www.experts.scival.com/uic/pubDetail.asp?t=pm&id=9516710&n=Benjamin+A+Goldberg&u_id=767
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