Double Myelomeningocele In The Thoracic And Lumbar Spine: A Case Report And Review Of Literature.

Abstract

Introduction: Neural tube defects (NTDs) are complex congenital spinal anomalies, with an estimated incidence of 1-2 cases per 1000 population. Meningomyelocele (MMC) represent one of the commonest types. Multiple MMCs are rare, with less than 10 reported cases in the English literature. We report the case of a 4-month female with double MMCs at the thoracic and lumbar levels. Case report: A 4-month-old patient with two cysts on the spine was born at term, by caesarian section from non-consanguineous parents. Folic acid supplementation was first used after the first 10 weeks of pregnancy. She underwent sonography in early pregnancy only. Clinically, she had two midline cysts; in the upper thoracic region measuring 6 by 8cm and the lumbar region measuring 8 by 10cm.  No other congenital anomalies were discovered, the patient's head measured 40.5 cm, with a patent anterior fontanelle, not tensed. Neurological examination showed paresis in lower limbs with no other deficits. Brain MRI  was normal. Spine MRI showed a meningocele at the thoracic region,  and a myelomeningocele at the lumbar region. She underwent myelomeningocele closure and monitored for any change in head circumference, she did not require any further interventions. Results: There were no postoperative complications. After one year of follow-up, she did not develop any deficits; a functional assessment showed improvement in motor function; the child is currently walking independently. Conclusion: Double myelomeningocele is a rare presentation of NTDs especially where the neurological function was preserved. Early management of NTDs can lead to good outcomes and better life quality.