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Previously undiagnosed diastematomyelia with bony spur as a cause of back pain in a 49-year-old patient with known psoriatic arthritis.

A 49-year-old female patient, successfully treated with etanercept for PsA, presented with new lumbar pain and intermittent left sided sciatica. MRI revealed a previously unknown significant diastematomyelia (without any cutaneous stigmata), with a bone spur dividing the spinal canal into two compartments at L2/L3 and splitting the lowpositioned (L3/L4) terminal conus (Fig. 1). There was no syrinx or other abnormality in the cord itself at this level. Diastematomyelia is a congenital abnormality causing splitting of the spinal cord, most commonly in the upper lumbar spine [1]. In most cases there is a single arachnoid space and dural sac, and no bony or fibrous separation [2]; the cord often re-unites below the separation. Presentation is usually in early childhood, especially in cases with significant abnormalities, with neurological symptoms and signs in the lower limbs, including sensory, motor and bladder control disturbance. Although in this case neurological abnormalities in the lower limbs were minimal, they may be progressive, and monitoring is required. Funding: No specific funding was received from any bodies in the public, commercial or not-for-profit sectors to carry out the work described in this manuscript.