Symptomatic Recurrence of Cervical Spine Myelomeningocele in an Adult Patient.

Abstract

Cervical myelomeningocele (MMC) is a very rare neural type defect that is usually discovered and managed in childhood. It is best described as a closed type of spinal dysraphism, where the posterior portion of the cervical thecal sac forms a pouch that bulges out through a narrow posterior spina bifida and contains spinal neural tissue with or without cerebrospinal fluid. We report a 47-year-old male patient who presented with neck pain and decreased ability to use his fingers that had progressed over 3 years before presentation. Cervical spine magnetic resonance imaging revealed a posterior bulge between the spinous processes of C4 and C6, absence of the spinous process of C5, and presence of cerebrospinal fluid and spinal cord tissue and nerve roots within the bulging sac, suggestive of MMC. Simple untethering of the cord tissue was sufficient to halt the progression and allow for improvement in neurological deficits. Cervical MMC is extremely rare in adults, the symptomatic progression of which is most likely because of cord tethering by fibrotic tissue formation over years. Early surgical correction and release of the tethered cord is relatively safe and prevents the evolution of neurological symptoms.