CASE REPORT   

Minerva Ortopedica e Traumatologica 2019 June;70(2):107-11

DOI: 10.23736/S0394-3410.19.03917-1

Copyright © 2019 EDIZIONI MINERVA MEDICA

lingua: Inglese

Dysraphism in scoliosis: a case report of diastematomyelia in severe right thoracolumbar congenital kyphoscoliosis

Massimo GIRARDO ¹, Alessandro RAVA ² ✉, Federico FUSINI ², Sara LEA ², Alessandro MASSÈ ², Pasquale CINNELLA ¹

¹ Unit of Spine Surgery, Department of Orthopedic and Traumatology, Orthopedic and Trauma Centre, Città della Salute e della Scienza di Torino, Turin, Italy; ² Department of Orthopedic and Traumatology, Orthopedic and Trauma Centre, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy

Diastematomyelia or split cord malformation (SCM) is a rare neuronal tube anomaly often associated with congenital scoliosis. It’s treatment nowadays is controversial and in literature several approaches are described. We report our case of a 16 years old female affected by a severe right convex thoracolumbar scoliosis (T1-L3 curve of 145°) associated to spine defects (hemivertebrae, rib fusion, block vertebrae, butterfly vertebra, SCM) and respiratory failure. After multidisciplinary discussion (including neurosurgeons and orthopaedics) we decided to treat the patient with a two staged approach. The first step consisted in a halo-pelvic traction maintained till surgery. In the second stage, the halo traction was removed and a surgical posterior arthrodesis (T2-L4) with pedicle screws and rods was performed. The X-rays evaluation were made after few days from surgery and at 1,3,6 and 12 months after surgery. Good radiographic results were obtained, and the Cobb angle correction was of 65°. Furthermore, the patient reported improvements on the respiratory function, underlined by the possibility of walking for long distances without fatigue and a great satisfaction with her aesthetical appearance. Clinical and radiological conditions remained stable during all FU. The management of congenital and rigid scoliosis in diastematomyelia is a hard challenge for every spine surgeon and several treatments are proposed. In our case we achieved an excellent result with a two staged treatment protocol. More studies are required to improve the knowledge about this problem.

KEY WORDS: Neural tube defects; Scoliosis, halo traction; Spinal dysraphism; Spine; Surgery