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Diastematomyelia

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This is a child that had spastic gait and

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was known to have spinal dysraphism.

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As we look at the T1-weighted scan, we would calculate

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that the cord ends at approximately the L4 level,

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therefore is low in location.

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We also see that the patient has a syrinx in

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the spinal cord at the L1-T12 level.

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And this is well demonstrated on the T2-weighted sequences.

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However,

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at the level of the spinal dysraphism you see

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that the spinous processes are missing

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here. We see this little bony bar which is extending

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to a fused L4 and L5 vertebral body segment.

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So this patient has a segmentation anomaly.

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A low spinal cord or tethered cord, has a syrinx.

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And then when we look at the axial scan, we see that there is

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a separation of two thecal sacs with this bony bar

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at the L4-L5 level, and then it reconnects

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to a low-lying conus, down at the L5-S1 level.

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So this is L5-S1.

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We scroll superiorly.

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We have the two portions of the cord separating by this

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diastematomyelia. And then as we go higher, they will fuse back,

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you see, into a single spinal cord with a syrinx.

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So this is an excellent

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example of all the potential associations of

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diastematomyelia. That is, it may have a syrinx,

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it may have a spinal dysraphism,

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it may have a tethered cord.

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And in this case,

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it's a separation by bone with the

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two hemicords coming together.

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Remember that each of these hemicords has just

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one side's nerve roots. So here's the left side.

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You don't see any nerve roots coming

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off of the right side of this hemicord.

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And you don't see any nerve roots coming

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off of the left side of this right hemicord.

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And then they combine together more inferiorly

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into the tethered cord. A wonderful case.

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And that's why I love diastematomyelia,

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in addition to the fact that it's

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approximately nine syllables.

Report

Faculty

David M Yousem, MD, MBA

Professor of Radiology, Vice Chairman and Associate Dean

Johns Hopkins University

Tags

Spine

Neuroradiology

Neuro

MSK

MRI

CT

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