Elsevier Editorial System(tm) for Journal of Pediatric Surgery Manuscript Draft Manuscript Number: Title: Diasmatomyelia (split cord malformations) Our Experience Article Type: Clinical Research Paper Keywords: Key words .Diasmetomeylia .Split cord malformations .Spinal dysraphism Corresponding Author: Dr. Umar Farooq, MBBS,MS(Neurosurgery) Corresponding Author's Institution: Pakistan Institute of Medical Sciences First Author: Umar Farooq, MBBS,MS(Neurosurgery) Order of Authors: Umar Farooq, MBBS,MS(Neurosurgery); Sami u Rehman, MBBS, MS (Neurosurgery); Nawaz Khan, MBBS, MS (Neurosurgery); Khaleeq u Zaman, MBBS,FRCS(SN),FCPS NEUROSUGERY Abstract: Abstract Object. Diasmetomeylia (split cord malformations) are rare anomalies of the spine. Total 18 cases were studied prospectively at author's center during period of one and half year. Methods. Patient's demographic profile, symptoms and signs, imaging studies, operative findings, complications, and outcomes were assessed prospectively. The mean age of the patient's was 6.33 years (male/female 3/1). Type I was seen in 7 cases (27.77%) and type II was seen in 11 cases (60.11%). Dermal manifestation were seen in all 18 cases (100 %); hypertrichosis 14 cases (77.77%), dimple 5 cases (27.77%), dermal sinus in 4 cases (22.22%) subcutaneous lipoma 5 cases (27.77%). Orthopedic deformity in 9 cases (50%). Neurological deficit present in 15 cases (83.33%). Asymptomatic were 3 cases (16.66%).All patients were treated surgically. Outcome 15 cases improved neurologically (87.5%), 1 case (12.5%) no improvement occurs. Two cases were lost to follow up. Complication in 4 cases (22.22%), 2 cases (11.11%) surgical site infections and urinary tract infection occurs in 2 cases (11.11%). Conclusions. The authors present 18 cases in one and half year. The patients with dermal manifestations should be referring for neurosurgical evaluation, prompt management before developing any other manifestations. Awareness program for pediatric physicians and general public should be done for better outcomes. Especially Parents should be counseled regarding folic acid supplement in future. A multicenter large study carried out to answer the challenges. Key words .Diasmetomeylia .Split cord malformations .Spinal dysraphism

SUGGESTED COVER LETTER FOR AUTHOR JOURNAL SUBMISSION Dear [Publisher or Editor name],

Enclosed is a manuscript to be considered for publication in ________________ [Journal

name]. The research reported in this manuscript has been funded through the National

Institutes of Health, and, therefore, its publication must comply with the NIH Public

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Cover Letter

TABLE 1. GUIDELINES FOR THE REPORTING OF CLINICAL RESEARCH DATA IN THE JOURNAL

OF PEDIATRIC SURGERY

Methods:

Reported Not

Applicable

Reporting Detail

1 The number and practice type of all institutions where cases were performed

2 The number of surgeons who actually operated in the study (& relative number of cases for each)

25 years The prior experience of participating surgeons in performing the reported intervention

January 2013 to

June 2014

The precise timeline during which all patients were treated in the study(i.e. Jan 1995 to March

1998)

Included were

having first

surgery all oother

were excluded

A clear description of how patients were selected into the study. This should include relevant

inclusion and/or exclusion criteria.

NA The number of eligible patients at the study sites excluded during the timeline of the study

18 A clear description of the study population from which the patients were selected

Yes standard

criteria

A clear description of the relevant diagnostic criteria used to identify cases

yes A clear description of critical aspects of operative technique and perioperative care

Yes for TYPE I

and TYPE II

Statement as to whether any attempts were made to standardize operative technique or perioperative

care (and how this was accomplished)

Results:

Reported Not

Applicable

Reporting Detail

yes The range and mean of all relevant demographic and baseline variables

yes The range and median (not mean) for length of follow-up reporting

NA Relevant outcome variables are presented with appropriate measures of range and variability

(i.e. standard deviation)

YES Methods for measuring outcomes of interest are clearly described

Lost to follow up Statement regarding whether any data is missing (and how missing data is addressed in the analysis

of outcome variables)

YES Number and appropriate details regarding all complications

Additional Details for Studies Reporting More Than One Treatment Group (e.g. Controls):

Reported Not

Applicable

Reporting Detail

NA Mean and range for all relevant demographic and baseline variables for all treatment groups

NA The range and median (not mean) for length of follow-up reporting for each treatment group

NA A precise timeline during which all patients were treated for each group

NA Outcome variables being compared between groups are presented with appropriate measures of

variability (e.g. standard deviation)

NA Measures to type II error (P-values) for comparison statistics are presented with actual values if

P=.01 or larger (e.g. P=NS and P<.05 are not acceptable)

NA A description of how patients were selected into each treatment group

NA A statement is made as to whether the same surgeons operated on patients from different treatment

groups Manuscripts concerning clinical research should follow a uniform set of reporting guidelines. The guidelines, listed above, were developed from

sound clinical research principles and are designed to improve the reporting accuracy of clinical data pertaining to surgical conditions. With more accurate and transparent reporting of study methodology and outcomes data, readers of the Journal will be better able to gauge the relevance

*Clinical Guidelines

of reported results to their own clinical practice. Although not all of the recommended reporting guidelines are applicable to every clinical study,

it is important that all details relevant to your study are clearly reported in the manuscript. Please check the appropriate boxes to verify compliance with these guidelines and submit with the manuscript. Compliance with these guidelines will be considered by the editor in the final

decision regarding publication of your manuscript.

Diasmatomyelia (split cord malformations)

Our Experience

Umar Farooq, Sami Ur Rehman, Muhammad Nawaz,

Prof. Khaleeq u Zaman.

*Title Page

Diasmatomyelia (split cord malformations)

Our Experience

Umar Farooq, Sami Ur Rehman, Muhammad Nawaz,

Prof. Khaleeq u Zaman.

Department of Neurosurgery, Pakistan Institute of medical sciences,

Islamabad, Pakistan.

*Abstract

Abstract

Object. Diasmetomeylia (split cord malformations) are rare anomalies of the

spine. Total 18 cases were studied prospectively at author’s center during period of

one and half year.

Methods. Patient’s demographic profile, symptoms and signs, imaging studies,

operative findings, complications, and outcomes were assessed prospectively.

The mean age of the patient’s was 6.33 years (male/female 3/1). Type I

was seen in 7 cases (27.77%) and type II was seen in 11 cases (60.11%). Dermal

manifestation were seen in all 18 cases (100 %); hypertrichosis 14 cases (77.77%),

dimple 5 cases (27.77%), dermal sinus in 4 cases (22.22%) subcutaneous lipoma 5

cases (27.77%). Orthopedic deformity in 9 cases (50%). Neurological deficit

present in 15 cases (83.33%). Asymptomatic were 3 cases (16.66%).All patients

were treated surgically. Outcome 15 cases improved neurologically (87.5%), 1

case (12.5%) no improvement occurs. Two cases were lost to follow up.

Complication in 4 cases (22.22%), 2 cases (11.11%) surgical site infections and

urinary tract infection occurs in 2 cases (11.11%).

Conclusions. The authors present 18 cases in one and half year. The

patients with dermal manifestations should be referring for neurosurgical

evaluation, prompt management before developing any other manifestations.

Awareness program for pediatric physicians and general public should be done for

better outcomes. Especially Parents should be counseled regarding folic acid

supplement in future. A multicenter large study carried out to answer the

challenges.

Key words .Diasmetomeylia .Split cord malformations .Spinal dysraphism

. Neurosurgery

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65

Diastematomyelia (split cord malformations): Our experience

Clinical article

Umar Farooq, Sami Ur Rehman, Muhammad Nawaz, Khaleeq UZ Zaman.

Department of Neurosurgery, Pakistan Institute of Medical Sciences, Shaheed Zulfiqar

Ali Bhutto Medical University, Islamabad, Pakistan.

Object. Diastematomyelia (split cord malformations) are rare anomalies of the spine.

Total 18 cases were studied prospectively at author’s center during period of one and a

half year.

Methods.Patient’s demographic profile, symptoms and signs, imaging studies, operative

findings, complications, and outcomes were assessed prospectively. The mean age of the

patients’ was 6.33 years (male: female 3:1). Type I was seen in 7 cases (27.77%) and

type II was seen in 11 cases (60.11%). Dermal manifestations were seen in all 18 cases

(100 %); hypertrichosis 14 cases (77.77%), dimple 5 cases (27.77%), dermal sinus in 4

cases (22.22%) subcutaneous lipomas in 5 cases (27.77%). Orthopedic deformity in 9

cases (50%). Neurological deficit present in 15 cases (83.33%). Neurologically intact

were 3 cases (16.66%). All patients were treated surgically. Outcome 15 cases improved

neurologically (87.5%), 1 case (12.5%) no improvement occurred. Two cases were lost to

follow up. Complications in 4 cases (22.22%), 2 cases (11.11%) surgical site infections

and urinary tract infection in 2 cases (11.11%).

Conclusions. The authors present 18 cases in one and a half year. The patients with

dermal manifestations should be referred for neurosurgical evaluation, prompt

management before developing any other manifestations. Awareness program for

pediatric physicians and general public should be done for better outcomes. Especially

Parents should be counseled regarding folic acid supplementation in future.

Key words. Diastematomyelia. Split cord malformations .Spinal dysraphism

plit cord malformations are rare congenital

anomalies in which the cord is split over a

portion of its length to form double neural

tubes or two hemicords in a single dural

sheath. Many of the affected children are

asymptomatic at birth, but neurological

deterioration occurs mostly within the first 2 to 3

years of life due to tethering of the cord by

tissues that pass through it (bone spurs or fibrous

bands) or by a thick terminal filum. We analyzed

18 patients with SCM surgically treated at our

center. We studied the clinical and imaging

profiles of these patients, as well as their

surgical outcomes and complications.

Clinical Material and Methods

Patient Population

A total of 18 patients with SCM were

treated surgically between January 2013 and

June 2014. Each patient’s age, sex, clinical

features, imaging studies, operative details,

associated bone and soft-tissue anomalies,

complications, and surgical outcome were noted

or evaluated in detail prospectively from

January2013 to June2014. All patients with a

diagnosis of SCM were treated surgically, even

if they were asymptomatic and neurologically

intact. The follow-up duration of these patients 2

weeks, 3 months and six months.

The mean age of the patients with

neurological deficits was 6.33 years, whereas

asymptomatic patients presented at a mean age

of 0.7 years. There were 12 male patients

(66.66%) and 6 female patients (33.33%).

S

*ManuscriptClick here to view linked References

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Table 1. Clinic-al picture and number of the

patients affected

Skin stigmata 18 (100%)

Spina bifida 4 (22.22%)

Scoliosis 2(11.11%)

Orthopedic lower

limbs deformity

9 (50%)

Sensory, motor and

autonomic

15 (83.33%)

Trophic ulcers 3 (16.66%)

Pain: Back and lower

limbs

15 (83.33%)

Imaging Studies

Magnetic resonance imaging of the

spine (for type and level of split, level of the

conus medullaris, thickness of the terminal

filum, presence of other associated tethering

elements, and syringomyelia) was performed,

along with a screening MR imaging study of the

brain and craniovertebral junction to look for

hydrocephalus, Chiari malformation, and

syringomyelia if symptoms were present. Plain

x-ray films of the spine were obtained to assess

for kyphoscoliosis and vertebral or rib

anomalies.

Surgical Procedures

Type I SCM.

A careful laminectomy or laminotomy

was performed around the attachment of rigid

septum. A laminotomy was used in patients with

well-formed laminae or in those who needed

exposure of the cord above or below the

dysraphic spine. The spur was then dissected

extradurally between the two dural sleeves and

removed piecemeal by using small rongeurs.

Fibrous adhesions were excised and dural

sleeves resected. The dura mater was opened

and the two dural tubes were converted to one

by suturing lateral margins of both dural tubes

at the midline. The terminal filum was cut in all

cases involving tethered or low-lying cords

through the same incision.

Type II SCM.

For patients with Type II SCM, the

laminectomy or laminotomy was performed at

the lower end and upper end of the split. The

dura was opened and the fibrous septum or

arachnoid adhesions were excised (associated

lesions tethering the spinal cord were also

corrected at the same time).The terminal filum

was also cut to minimize the traction on the

conus medullaris.

Results

Clinical Features

The presenting symptoms can be classified as

skin stigmata,spina bifida aperta, scoliosis or

kyphoscoliosis, musculocutaneous deformities

of the lower limb, and sensorimotor and

autonomic deficits (Table 1).

Table 2. Neurological deficit and number of

patients affected

Motor 15 (83.33%)

Sensory 15 (83.33%)

Autonomic 10 (55.55%)

Sensory, motor and

autonomic

10 (55.55%)

Neurologically intact 3 (16.66%)

Motor deficits consisted of weakness and

atrophy of the limbs and gait disturbances were

present in 15 patients (83.33%), whereas sensory

complaints in 15 patients (83.33%) were mainly

in the form of dysesthetic pain, hypesthesia, and

trophic ulcers. Bladder and bowel disturbances

were noted in 10 patients (55.55%), the majority

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of whom presented with symptoms of urinary

tract infections. Their symptoms included

urinary frequency and urgency, a feeling of

incomplete voiding, poor voluntary control and

urge, and stress incontinence (frequent dribbling

of urine that increased on crying). Three patients

(16.66%) had no neurological deficits (Table 2).

Table 3. Cutaneus markers and number of

patients affected

Hypertrichosis 14 (77.77%)

Dimple 8 (44.44%)

Dermal Sinus 6 (33.33%)

Subcutaneus lipoma 5 (27.77%)

Some form of cutaneous markers was found in

all 18 patients, and hypertrichosis was the most

common skin manifestation, being present in

14(77.77%) patients (Table3). Of the orthopedic

anomalies of the lower limb seen in 9 patients,

congenital talipes equinovarus was the most

common (5 patients). Shortening of one limb

was seen in 2 cases (11.11%), pes planus (flat

foot) in 2 cases (11.11%), and scoliosis 2 cases

(11.11%; Table 4).

Table 4. Orthopedics deformity: total 9 cases

Talipes Equinovarus 5 (27.77%)

Scoliosis 2 (11.11%)

Pes planus 2 (11.11%)

No orthopedics

deformity

9 (50%)

Imaging Findings

Plain x-ray films of the spine and chest revealed

a number of deformities of the vertebrae and

ribs. Scoliosis or kyphoscoliosis was present in 2

patients (11.11%) on imaging. Magnetic

resonance imaging revealed lesion causing

tethering in 15 cases (83.33%). The cord was

low lying in 12 cases (66.66%), whereas Chiari

malformation was not noted. The lumbar and

thoracolumbar regions were the most common

sites involved (in 4 [22.22%] and 14 patients

[77.77%], respectively), and the cervical region

was not involved (Table 5).The breakdown of

patients with Type I and Type II SCM was 7

(31.66%) and 11 (69.13%), respectively.

Table 5. Site of SCM and number of patients

affected

Type I 7 (38.88%)

Type II 11 (61.11%)

Cervical 0 (0%)

Dorso-lumbar 10 (55.55%)

Dorsal 4 (22.22%)

Lumbar 4 (22.22%)

Intraoperative Findings

There were four lumbar SCMs and 14

thorocolumbar SCMs in our series. In seven

patients the spur arose dorsally from the surface

of the neural arch. Various other lesions causing

tethering were observed, including a thick or

tight terminal filum, intradural lipoma, dermoid

or dermal sinus tract. Myelomeningoceles

manqué arising from the paramedian dorsal

surface of the hemicords projecting dorsally and

caudally from their point of origin from the cord

and attaching or penetrating the dura caudally

were noted in 5 (77.42%) of 7 cases of SCM

Type I and in 9 (81.81%) of 98 cases of Type

II. These bands constitute an important cause of

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tethering and whenever encountered they were

divided from their visible dural connections so

that hemostasis was ensured. The ventral surface

of the cord was inspected in all cases to look for

any paramedian ventral nerve roots, but none

was found in the present series. The cord was

detethered through an upper midline incision at

the site of a bone or fibrous spur and a thick,

tight terminal filum was excised through a lower

incision. Type II SCM is characterized by a

fibrous or membranous spur causing the split

and leading to two hemicords in a single dural

sleeve. The dura was opened and the fibrous

septum or arachnoid adhesions were excised

(associated lesions tethering the spinal cord were

also corrected at the same time). The dura mater

was opened and the two dural tubes were

converted to one by suturing lateral margins of

both dural tubes at the midline.

Patient Outcome

All of the patients were followed up 2

weeks after discharge and again at 3- to 6-

months intervals. Of the symptomatic patients,

14 (77.77%) showed improvement in motor

power, 14 (77.77%) of 15 improved with regard

to sensory symptoms, and 9 (90%) of 10

regained continence. Significant healing of

trophic ulcers was seen in 1 (50%) of 2 patients.

Neurological status was static in 1 (5.55%) of 18

patients. No patients showed neurological

deterioration. Neurological deficits improved

gradually. Three patients had permanent deficits,

and the one did not improved after 6 months of

follow up. Two patients were lost to follow up.

(Table 6). Postoperative complications were

present in 4 patients (22.22%) and two patients

(11.11%) had wound infections. All of these

issues were managed conservatively, and the

wounds healed well. Urinary tract infections

developed in 2 patients (11.11%). There were no

operative deaths. Among the symptomatic

patients, none suffered fresh neurological

deficits.

.

Table 6. Outcome

Parame

ter

Num

ber of

cases

Impro

ved

Deterior

ated

Unchan

ged

Motor 15 14 Nil 1

Sensor

y

15 14 Nil 1

Sphinct

ers

10 7 Nil 3

Lost to follow up: 2 patients

Post complications in 4 patients (22.22%):

2 cases of UTI (11.11%)

2 cases of SSI (11.11%)

Discussion

Despite the well-accepted unified theory

of embryogenesis proposed by Pang, et al., 14

significant confusion exists. These authors

hypothesized that all SCMs result from the basic

error in formation of the accessory neurenteric

canal between the yolk sac and amnion, which is

subsequently invested with mesenchyme to form

the endomesenchymal tract that splits the

notochord and the neural plate. The common

embryological error in SCM involves the

formation of an abnormal fistula through the

midline embryonic disc that maintains

communication between the yolk sac and

amnion and makes possible continued contact

between the ectoderm and endoderm. This

abnormal fistula necessarily leads to regional

splitting of the notochord and the overlying

neural plate. The formation of the abnormal

fistula is the crucial step, and further

developments around the fistula occur

subsequently. As the result of adhesion between

the ectoderm and endoderm, the surrounding

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multipotential mesenchyme condenses around

the fistula to form an endomesenchymal tract

that not only permanently bisects the notochord

but also forces each overlying hemineural plate

to neurulate against its own hemicord. The basic

malformation therefore consists of two

heminotochords and two hemineural plates

separated by a midline tract containing

ectoderm, mesenchyme, and endoderm.14

Further

evolution of this basic form into the full-grown

malformation depends on the ability of the

heminotochords and hemicords to heal around

the endomesenchymal tract, the developmental

fates of the three germ elements within the tract,

the variable extent to which the

endomesenchymal tract persists, and the

interaction between the heminotochord and the

hemineural plates during neurulation. Unlike the

case of the endoderm, some derivatives of the

mesenchymal component almost always persist

in the midline cleft of the mature SCM. Meninx

precursors possess a dual fibrogenic and

sclerogenic capability and are the likely source

of midline bone, apart from formation of the

dural tubes. Because normal arachnoid tissue is

derived from the inner lining of the primitive

meninx after the formation of the dura, the side

of the median dura facing the hemicord will

form half of a complete arachnoid tube that

ultimately surrounds each hemicord, whereas the

side of the median dura facing the midline forms

the bone spur. The extent of disappearance of

the endomesenchymal tract and the subsequent

interaction of primitive meninx with the midline

tract remnant are probably genetically

controlled, but further research needs to be done

for this hypothesis to be substantiated.

Uncommon congenital anomalies of the spinal

cord, SCMs are seen more often in female

patients: Pang, et al., 14

reported a female/male

ratio of 1.5:1, and we found in our series (1:3).

Our patients usually presented in two peaks: the

first between 2 and 5 years of age and the

second in a rapid growth phase between 12 and

16 years of age. The mean age of our patients

was 6.33 years; however, the mean age for

neurologically intact patients was 0.7 years.

Four patients in our study were adults older than

16 years of age. Thoracolumbar and lumbar

regions were the most common sites.2, 7,

11,14Cervical and cervicodorsal SCMs are rare,

3,4

and we recorded no incidence. As in other

series, we observed skin lesions frequently in

patients with SCM, hypertrichosis being the

most common. One or more skin manifestations

were present in 14 patients (77.77%).

Asymmetric weakness of the lower

limbs was the most common neurological

deficit and was present in 14 cases (77.77%).

Sphincter disturbances are often described in

patients with SCM.1, 6, 9,11,12,14.

The bladder and

bowel disturbances we saw in 55.55% of our

patients are easily explained by their delayed

referral to our center. In 1992, Pang, et al14

,

recommended surgical treatment even for

asymptomatic adults who led an active lifestyle.

Miller, et al., 13

noted neurological deterioration

in patients with SCM who did not undergo

surgery. In our study, the average age of

symptomatic patients was higher than that of

asymptomatic ones. Ers¸ahin, et al.,5 also

observed that the age and duration of

symptoms in patients with deficits were

significantly greater than in those without

deficits. The risk of neurological deficits

developing increases with age because of

progressive tethering of the spinal cord. 6, 8, 11

The

deficit also depends on associated anomalies

such as syringomyelia and on associated

lipomeningomyeloceles and congenital tumors

such as dermoids and epidermoid lesions.

Overall, the outcome also depends on anomalies

of other systems.6, 7,10,14

. The particular SCM I

subtype is also an important factor determining

neurological outcome. According to our

experience, Type I is the easiest to address

surgically with the least chance of deterioration

because of the significant space above and

below the bone spur. On the other hand, surgery

is much more difficult in patients with SCM

Type II because of the lack of space for

manipulation above and below the lesion.

Hence, chances of postoperative deterioration

are maximal in Type II SCM. Most surgeons

agree that early surgery is the key issue in the

management of SCM; however, although many

authors recommend prophylactic surgery 6, 11,14

others may not agree because of the risk of

neurological deterioration. Nonetheless, the fact

remains that once a neurological deficit appears,

there is a low chance of complete recovery. In

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the present series, 15 patients had motor deficits

and 14 (77.77%) of them showed varying

degrees of improvement. Sensory improvement

was seen in 77.77% of patients with

preoperative sensory disturbances. The chances

of autonomic improvement are lower still,

reportedly in the range of 15 to 40%.2, 7, 11

. In the

present series, autonomic disturbances improved

in 38.88% of patients. These observations

emphasize the role of surgery in neurologically

intact patients to prevent future neurological

deterioration.

Conclusions

Split cord malformations are rare

anomalies of the spinal cord, and we present the

largest prospective series so far reported in the

world literature. The risk of neurological deficits

developing increases with age. We recommend

prophylactic surgery for all asymptomatic

patients with SCM. Cutaneous markers should

be an important pointer for investigations for

occult spinal dysraphism, which was present in

100% of the patients in our series. All of the

patients with congenital and progressive

scoliosis should be screened with MR imaging.

The entire neuraxis should be evaluated and any

tethering lesions found should be simultaneously

treated at the time of the first surgery. Surgery

must be planned meticulously according to the

SCM type. Parents, pediatricians and

gynecologists should be counseled regarding

use folic acid during pregnancy.

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*References

Table 1. Clinic-al picture and number of the patients affected

Skin stigmata 18 (100%)

Spina bifida 4 (22.22%)

Scoliosis 2(11.11%)

Orthopedic lower limbs deformity 9 (50%)

Sensory, motor and autonomic 15 (83.33%)

Trophic ulcers 3 (16.66%)

Pain: Back and lower limbs 15 (83.33%)

Table 2. Neurological deficit and number of patients affected

Motor 15 (83.33%)

Sensory 15 (83.33%)

Autonomic 10 (55.55%)

Sensory, motor and autonomic 10 (55.55%)

Neurologically intact 3 (16.66%)

Table 3. Cutaneus markers and number of patients affected

Hypertrichosis 14 (77.77%)

Dimple 8 (44.44%)

Dermal Sinus 6 (33.33%)

Subcutaneus lipoma 5 (27.77%)

Table 4. Orthopedics deformity: total 9 cases

Talipes Equinovarus 5 (27.77%)

Scoliosis 2 (11.11%)

Pes planus 2 (11.11%)

No orthopedics deformity 9 (50%)

Table 5. Site of SCM and number of patients affected

Type I 7 (38.88%)

Type II 11 (61.11%)

Cervical 0 (0%)

Dorso-lumbar 10 (55.55%)

Dorsal 4 (22.22%)

Lumbar 4 (22.22%)

Table/Figure Legends

Table 6. Outcome

Parameter Number of cases Improved Deteriorated Unchanged

Motor 15 14 Nil 1

Sensory 15 14 Nil 1

Sphincters 10 7 Nil 3

Lost to follow up: 2 patients

Post complications in 4 patients (22.22%):

2 cases of UTI (11.11%)

2 cases of SSI (11.11%)

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