Advanced neurosurgical intervention of recurrent tethered cord syndrome with split cord malformation type 1: an illustrative case

This case underscores the complexity of managing recurrent TCS with SCM Type I, particularly when prior surgery is incomplete or complicated by spinal instrumentation. Key technical considerations include removal of the bony septum, resection of the medial dura to prevent recurrence, and careful dissection through scarred neural tissue. Preoperative planning with multidisciplinary coordination and intraoperative neurophysiological monitoring is essential to optimize outcomes. This report contributes to the limited literature on recurrent SCM management in adults and reinforces the importance of complete initial intervention and longitudinal follow-up in complex spinal dysraphisms.