CERVICO DORSAL SPINAL DYSRAPHISM - AN INSTITUTIONAL EXPERIENCE

Introduction: Spinal dysraphisms are most common congenital anomalies of central nervous system.Cervicodorsal spinal dysraphisms are rare compared to lumbosacral dysraphism, with incidence of 1-6%. Associated anomalies such as split cord malformation, hydrocephalus, Arnold chiari malformation, corpus callosum agenesis, are frequently seen in cervico dorsal compared to lumbosacral dysraphism. In our study, we highlighted the clinical spectrum, associated anomalies, surgical nuances and outcomes of cervicodorsal spinal dysraphism presented to department of neurosurgery, coimbatore medical college hospital, coimbatore. Material and Methods: This study includes patients with cervico dorsal spinal dysraphism, presented to Department of neurosurgery, coimbatore medical college hospital,Coimbatore between 2015–2019. All patients underwent neurological and radiological examination and associated anomalies were addressed accordingly either prior to or along with definitive treatment. The last available follow up in hospital recordings was taken for outcome assessment. Results: A total of 13 patients with cervico dorsal spinal dysraphism were operated between 2013 and 2019. Among them 5 [40%] were of cervical region and 8[60%] were of thoracic region.The age at time of admission was from 10days to 10years.There were 10 female and 3 male children. The most common presentation was isolated swelling.Mild lower limb weakness in 2 cases (1 cervical and 1 thoracic). There were also no orthopedic abnormalities.3 patients had hydrocephalus , of them chiari type 2 malformation was found in two cases(1 cervical and 1 thoracic).Diastematomyelia was seen in 5 patients. All cases were evaluated extensively with Magnetic Resonance imaging of Spine with Brain screening and the case associated with split cord malformation was further evaluated by CT scans. All patients underwent surgical excision of the sac and exploration of the indradural sac using the standard technique.Hydrocephalus was treated with ventriculo-peritoneal shunt, Diastematomyelia was treated with excision of bony spur and reconstruction of Dural tube. Conclusion: Cervicothoracic spinal dysraphism has more favourable outcome in respect to Neurological, orthopaedic and urologic problems compared to lumbosacral Dysraphism.Surgical treatment consisting intradural exploration of Lesion,untethering of spinal cord and excision of potential adhesions should be Performed in early period to prevent neurologic deterioration. Patient outcome depends on presence of associated anomalies and whether complete resection is performed.