Widely separated composite split cord malformation

Abstract

Discussion n The presence of SCMs at multiple levels is a rare occurrence; seen in less than 1% of total cases of SCMs.1 Only few case reports of such anomalies are available in the published literature.2–4 Most of these cases had two spurs at different levels and one case having two different types of spurs at three different levels.5 In most of these cases the spurs were not more than three vertebral levels apart. Emura et al10 and Klessinger reported an experimental animal model of SCM produced by surgical induction of a fistula.11 Even though the results of their study supported the hypothesis that SCMs originate from an accessory neuroenteric canal, it is difficult to explain all variations of SCMs. Conclusion n Existence of a type I malformation, immediately next to a type II lesion (composite SCM) in the same patient lends support to unified theory, but separation of these two by more than 10 vertebral levels is an extremely rare embryological event and can be explained only by the presence of another accessory neuroenteric canal, as proposed by Bremer.