Surgical fixation of a unilateral bar and unsegmented butterfly vertebra in a patient with diastematomyelia and a tethered cord: illustrative case
Year: 2026
Type: article
Study design: Case Report
Abstract: BACKGROUND: There is a paucity of literature to guide the surgical management of the simultaneous presentation of a diastematomyelia, two hemicords, and a unilateral bar unsegmented vertebra, a form of formation failure. OBSERVATIONS: An 11-year-old female presented with acute-onset back pain, urinary incontinence, and lower extremity numbness. Evaluation revealed T7 diastematomyelia with a tethered cord and a right-sided T6-11 nonsegmented unilateral bar, resulting in thoracolumbar levoscoliosis (maximal Cobb angle of 49°). Initial surgical decompression and spinal cord detethering were performed, including a T7 laminectomy. A bony septation attached to the lamina and projecting through the dura mater and cord was removed and the cord was detethered. The patient subsequently regained neurological function. Eight months later, repeat scoliosis radiographic imaging showed progression to a maximal Cobb angle of 58.4°. The patient then underwent a second-stage T2-L3 posterior lateral fixation and fusion with a pedicle screw-rod construction. The postoperative curve magnitude was 25.2°. Five years following operation, she required no revision surgery and remained neurologically intact. LESSONS: The authors present a successful surgical correction of concomitant diastematomyelia and a unilateral bar and unsegmented butterfly vertebra in a pediatric patient. While the curve magnitude at presentation warranted surgical correction, neurological deficits necessitated urgent decompression before stabilization. https://thejns.org/doi/10.3171/CASE25315.
DOI: 10.3171/case25315
Authors: Luke Mugge, Duy Pham, Aqib Zehri, Danielle Dang, Cristie Brewer, Peggy Vollstad, Leon E. Moores, Brian McHugh
Institutions: Inova Health System, University of Virginia, Oregon Clinic
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W7127327303
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