Spectrum of Spinal Dysraphism in Pediatric Patients in a Tertiary Care Hospital

  • Musawer Khan Neurosurgeon
  • Arif Hussain Department of Neurosurgery, MTI Lady Reading Hospital
  • Huma Gul District Headquarters Hospital, Mardan
  • Ambreen Syed Hayatabad Medical Complex, Peshawar
Keywords: Spinal Dysraphism, Endoscopic third Ventriculostomy, Ventriculoperitoneal, Myelomeningocele, Tethered Cord Syndrome


Objectives:  To report the spectrum of spinal dysraphism presenting in pediatric patients admitted to the Department of Neurosurgery Lady reading hospital Peshawar.

Material & Methods:  A descriptive case series was conducted and total of 89 patients (age between 2 months to 12 years) were included who underwent the surgical treatment. All patients were examined for clinical and radiological diagnosis of spinal dysraphism.

Results:  The average age at treatment was 23 ± 39.77 months. The most recurring (52.8%) presenting symptom was the swelling on the back followed by lower limb weakness. Meningocele was reported in 11.2%, myelomeningocele in 47.2%, myelomeningocele & hydrocephalus in 12.4%, tethered cord syndrome in 25.8%, and diastematomyelia 3.4% of patients. Excision combined with the repair was done in 58.4%, release & repair done in 29.2% and endoscopic third ventriculostomy/ventriculoperitoneal shunts with the repair were done in 12.4% patients. Cerebrospinal fluid leak was reported in 3.7%, wound infection in 4.5% and mortality was reported in 3.4% patients.

Conclusion:  Overall, a good outcome was reported in the majority of our patients. Surgical procedures like myelomeningocele’s excision & repair, tethered cord’s release & repair, and ETV/VP shunt in patients with hydrocephalus can lead to satisfactory clinical outcomes.


1. Reghunath A, Ghasi RG, Aggarwal A. Unveiling the tale of the tail: an illustration of spinal dysraphisms. Neurosurgical review. 2019 ;7:1-8.
2. Thompson DN. Spinal dysraphic anomalies; classification, presentation and management. Paediatrics and Child Health. 2014;24(10):431-8.
3. Sweet J, Kalhorn CG. Spinal dysraphism: a review of clinical manifestations and surgical treatment options. InSeminars in Spine Surgery 2005; 17(1): 23-29. WB Saunders.
4. Venkataramana NK. Spinal dysraphism. Journal of pediatric neurosciences. 2011;6(Suppl1):S31.
5. Agrawal A, Sampley S. Spinal dysraphism: A challenge continued to be faced by neurosurgeons in developing countries. Asian journal of neurosurgery. 2014;9(2):68.
6. Assaad A, Mansy A, Kotb M, Hafez M. Spinal dysraphism: experience with 250 cases operated upon. Child's Nervous System. 1989;5(5):324-9.
7. Acharya UV, Pendharkar H, Varma DR, Pruthi N, Varadarajan S. Spinal dysraphism illustrated; Embroyology revisited. The Indian journal of radiology & imaging. 2017;27(4):417.
8. Hudgins RJ, Gilreath CL. Tethered spinal cord following repair of myelomeningocele. Neurosurgical focus. 2004 Feb 1;16(2):1-4.
9. Boop FA, Russell A, Chadduck WM. Diagnosis and management of the tethered cord syndrome. The Journal of the Arkansas Medical Society. 1992;89(7):328-31.
10. Hudgins RJ, Gilreath CL. Tethered spinal cord following repair of myelomeningocele. Neurosurgical focus. 2004;16(2):1-4.
11. Guggisberg D, Hadj-Rabia S, Viney C, Bodemer C, Brunelle F, Zerah M, Pierre-Kahn A, de Prost Y, Hamel-Teillac D. Skin markers of occult spinal dysraphism in children: a review of 54 cases. Archives of dermatology. 2004;140(9):1109-15.
12. Warder DE. Tethered cord syndrome and occult spinal dysraphism. Neurosurgical focus. 2001 Jan 1;10(1):1-9.
13. Gower DJ, Del Curling O, Kelly Jr DL, Alexander Jr E. Diastematomyelia–a 40-year experience. Pediatric Neurosurgery. 1988;14(2):90-6.
14. Rilliet B. Diastematomyelia. InThe Spina Bifida 2008 (pp. 487-513). Springer, Milano.
15. Pang D. Surgical complications of open spinal dysraphism. Neurosurgery Clinics of North America. 1995;6(2):243-57.
16. Elmesallamy WA, Taha MM. Surgical management and prognostic factors of spinal metastatic tumors. Egyptian Journal of Neurosurgery. 2020;35:1-8.
17. Kumar R, Singh SN. Spinal dysraphism: trends in northern India. Pediatric neurosurgery. 2003;38(3):133-45.
18. Etus V, Ceylan S. Success of endoscopic third ventriculostomy in children less than 2 years of age. Neurosurgical review. 2005;28(4):284-8.
19. Jindal A, Mahapatra AK, Kamal R. Spinal dysraphism. The Indian Journal of Pediatrics. 1999;66(5):697-705.
20. Marreiros H, Loff C, Calado E. Osteoporosis in paediatric patients with spina bifida. The journal of spinal cord medicine. 2012 Jan 1;35(1):9-21.
21. Cornette L, Verpoorten C, Lagae L, Van Calenbergh F, Plets C, Vereecken R, Casaer P. Tethered cord syndrome in occult spinal dysraphism: timing and outcome of surgical release. Neurology. 1998;50(6):1761-5.
22. Jones RF, Stening WA, Brydon M. Endoscopic third ventriculostomy. Neurosurgery. 1990;26(1):86-92.
Original Articles