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An Unusual Case of Spinal Dysraphism with Four Splits Including Three Posterior Spurs

Background: Composite-type split spinal cord malformation (SCM) is very rare and results from 2 separate foci of ectoendodermal adhesions and endomesenchymal tracts leading to the development of SCM with an intervening normal cord in the same patient. Posterior spurs are even rarer. We report a unique case of composite SCM, where the patient had 3 posterior bony spurs and 1 fibrous spur at different levels. To our knowledge, this is the first reported case of a patient having composite-type SCM with posterior spurs at 3 different levels. Clinical Presentation: A 3-year-old girl presented to us with progressively worsening scoliosis. Neurological examination was unremarkable except for mild weakness in the left lower limb. Three-dimensional CT imaging demonstrated posterior bony spurs located at T6, T12 and L3 levels. The patient underwent T11–L5 laminoplasty and T5/T6 laminectomy and excision of SCM type 1 with division of the thickened filum terminale. All the bony spurs arose from the inner surface of the lamina, where the base of the spur was located. Conclusions: The unique point of this case report is the rarity of such a presentation. Careful planning and knowledge of the occurrence of such conditions can make surgery in these children safe, and all the levels can be treated in a single setting.