Key Clinical Findings & Highlights
- First-ever reported clinical documentation of triple spinal cord hemicords (Triplomyelia).
- Presents detailed embryological mechanism and microsurgical spur excision.
- Prevents progression of pediatric scoliosis and lower-limb neurological deficits.
Abstract
Introduction & Background
According to the unified embryological theory of Pang et al., split cord malformations arise from the development of an accessory neurenteric canal between the yolk sac and amnion during early blastogenesis. The presence of three distinct hemicords represents an exceptionally complex variant of abnormal gastrulation.
Clinical Case Presentation & Diagnosis
An 8-year-old girl presented with progressive gait disturbance, asymmetric lower limb atrophy, and a cutaneous tuft of hair in the lower lumbar spine. High-resolution 3D T2-weighted MRI and thin-slice CT revealed a Type I split cord malformation with a rigid bony spur at L3. Remarkably, axial imaging demonstrated three separate, parallel spinal cord hemicords, each containing a central canal and independent anterior and posterior rootlet origins.
Surgical Technique & Management
L3-L4 laminectomy was performed. The prominent osseous spur was resected using diamond high-speed micro-drill. Following dural division and reconstruction, the three hemicords were completely freed from fibrous dural adhesions and detethered, restoring spinal pulsation.
Discussion & Literature Context
This case expands the understanding of primary dysraphic spectrums. Careful microsurgical detethering prevents progressive neurological deterioration, scoliosis progression, and foot deformities during childhood growth spurts.
Conclusion
Triplomyelia is a newly characterized variant of split cord malformation that responds favorably to timely microsurgical bony spur resection and detethering.
How to Cite This Research
C. S. Gandhoke, Dr. Surendra K. Gupta, A. K. Sharma, S. Ayalasomayajula, M. Sinha (2020). "Triplomyelia in a case of diastematomyelia: A new entity". Surgical Neurology International, Volume 11, Article 324.
