Clinical characteristics and surgical outcomes of split cord malformations: A retrospective analysis

Background: Split cord malformation (SCM) is a rare congenital anomaly characterized by a longitudinal division of the spinal cord into two hemicords. Clinical manifestations are diverse, often including neurological, orthopedic, and cutaneous abnormalities. Surgical management remains the mainstay of treatment, though outcomes and complication profiles require further study. This study aimed to analyze the clinical spectrum, surgical management, and outcomes of pediatric and young adult patients with SCM. Methods: A retrospective review was conducted of patients with SCM who underwent surgery at our tertiary care institute between 2018 and 2024. From 168 identified cases, 35 patients with complete clinical, radiological, and surgical data were included. Demographics, clinical features, radiological findings, operative details, and postoperative outcomes were recorded. Descriptive statistics were generated using GNU PSPP 2.0.0. Results: Among 35 patients (18 males, 17 females; mean age 5.4 years, range 2 months–20 years), SCM Type II was more common (62.9%) than Type I (37.1%). Motor deficits (77.1%) were the predominant presentation, followed by bowel/bladder involvement (51.4%). Cutaneous markers were observed in 45.7% and skeletal anomalies in 65.7%. Radiological findings included tethered cord (60%), low-lying cord (22.9%), and lipomyelomeningocele (17.1%). All patients underwent laminectomy with septum excision and dural repair; intraoperative neuromonitoring was used in 40%. Postoperative complications were minimal (cerebrospinal fluid leaks 8.6%, wound dehiscence 2.9%, and re-exploration 5.7%). Neurological outcomes were favorable, with 59.3% improving in motor deficits and no patient experiencing deterioration. Conclusion: SCM is a complex congenital anomaly often associated with cutaneous and skeletal markers. Surgical treatment is safe and effective, with most patients achieving neurological improvement or stabilization and a low complication rate. Early recognition and comprehensive surgical management are crucial to preventing long-term morbidity.