Cervical wart-like cutaneous appendage with a contiguous stalk of limited dorsal myeloschisis treated with untethering after long-term follow-up.

Background: Limited dorsal myeloschisis (LDM) is a condition in which the separation of the neuroectoderm from the cutaneous ectoderm during primary neural tube formation results in localized disjuncture, causing a continuous cord-like connection and spinal cord tethering. We reported a case of cervical LDM with a wart-like cutaneous appendage that was treated with excision after long-term follow-up.

Case description: The patient was an 18-year-old girl. A wart-like cutaneous appendage was noted over the nape of the neck since birth. Computed tomography showed spina bifida in the cervical and thoracic spines, and spinal magnetic resonance imaging (MRI) showed a cervical skin lesion and an enlarged dural sac in the dorsal thoracic spinal cord. At 18 years of age, the patient occasionally experienced numbness in her left hand and was referred to our outpatient clinic due to a new high signal intensity in the dorsal cervical spinal cord on a T2-weighted MRI. The MRI showed that a cord-like object was continuous intradural and dorsal to the spinal cord from a cutaneous lesion in the median cervical region, with a high signal in the same region. Symptomatic cervical spinal cord tethering due to a cord-like material was diagnosed, and the patient underwent resection. During surgery, the tract was removed from the cutaneous lesion into the dura mater as a single mass and untethered in the dorsal spinal cord. The histological diagnosis was a pseudo-dermal sinus tract with no luminal structures or neural tissue present, as the cord-like substance was connective tissue containing small blood vessels. Based on the neuroimaging and pathological findings, the patient was diagnosed with cervical LDM. Neurological symptoms improved postoperatively.

Conclusion: Herein, we reported a case of cervical LDM that was treated after long-term follow-up. The patient's symptoms improved immediately after surgery. Cervical LDMs are rare, and the timing of surgery for LDM should be considered according to the patient's condition.