Split cord malformation surgery addresses rare congenital anomalies that occasionally remain hidden until adulthood. While clinicians usually detect these conditions in children, adults may present with progressive symptoms like leg weakness. A recent case involved a 37-year-old man who experienced six months of neurological decline. His symptoms included urinary urgency and radiating back pain. Consequently, diagnostic imaging became essential to identify the underlying pathology.

Techniques for Effective Split Cord Malformation Surgery

MRI revealed a Type I SCM and a lipoma extending through a dorsal bony defect. Therefore, the surgical team planned a comprehensive intervention. First, they performed a posterior L2-4 lumbar laminectomy to reach the affected area. During the procedure, the surgeons excised the bony spur and resected the spinal cord lipoma. Additionally, they sectioned the fatty filum terminale to ensure complete detethering. Specifically, the use of a CO2 laser facilitated careful debulking. This technology allowed the team to develop surgical planes while minimizing tension on the sensitive cord. Ultimately, this multi-step approach successfully relieved the patient's symptoms.

Lessons from Adult Presentations

Adult-onset tethered cord syndrome requires a high index of clinical suspicion. Because the condition is congenital, many patients remain asymptomatic for decades. However, minor trauma or aging can trigger sudden neurological deterioration. Surgeons must prioritize the removal of both bony and fibrous septa to achieve successful results. Furthermore, meticulous debulking of intradural lipomas helps prevent further cord compression. Clinicians should also consider sectioning the filum terminale as a routine part of the untethering process to achieve the best outcomes.

Frequently Asked Questions

What defines a Type I Split Cord Malformation?

A Type I SCM consists of two hemicords, each contained within its own dural sheath. These hemicords are typically separated by a median bony or cartilaginous spur. Surgical intervention focuses on removing this spur to reconstitute a single dural tube.

How does the CO2 laser benefit this surgery?

The CO2 laser enables precise debulking of intradural lipomas with minimal mechanical trauma. It helps surgeons identify clear interfaces between neural structures and fatty tissue. Consequently, it reduces the physical tension applied to the spinal cord during resection.

Disclaimer: This content is for informational and educational purposes only. It does not constitute professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Refer to the latest local and national guidelines for clinical practice.

References

Baumgartner ME et al. Surgical treatment of a combined split cord malformation and spinal cord lipoma: illustrative case. J Neurosurg Case Lessons. 2026 Feb 16. doi: undefined. PMID: 41698193.

Mahapatra AK. Split cord malformations—a study of 254 cases. Indian J Pediatr. 2011;78(11):1393-1397.

Pang D. Split cord malformation: Part II: Clinical syndrome. Neurosurgery. 1992;31(3):481-500.