{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T20:53:35Z","timestamp":1773435215109,"version":"3.50.1"},"reference-count":24,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"9","license":[{"start":{"date-parts":[[2021,3,1]],"date-time":"2021-03-01T00:00:00Z","timestamp":1614556800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,3,1]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Conjoined twins represent a rare congenital malformation. Pygopagus twins are fused at the sacrum and perineum, with union of the spine. The authors report a successful separation of a unique case of pygopagus twins sharing a U-shaped spinal cord, which the authors identified through aberrant nerves by intraoperative physiological spinal root examination.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>The 6-month-old male pygopagus conjoined twins, who were diagnosed in the prenatal period, underwent separation. They had a single dural sac containing a U-shaped continuous spinal cord; their filum terminale appeared completely fused and the anatomical border of the spinal cord was not distinguishable. A triggered electromyogram (tEMG) was used on each nerve root to determine which belonged to one twin versus the other, to detect nerve cross, and to identify functional midline cleavage. Finally, the twins were separated after spinal division. Both twins recovered uneventfully with no lower limb neurological deficits or walking impairment for 16 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>Pygopagus twins with a conjoined spinal cord are very rare, but a good long-term functional prognosis can be expected with successful separation. Intraoperative tEMG is useful in spinal separation surgery for twins with a conjoined spinal cord.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case218","type":"journal-article","created":{"date-parts":[[2021,3,1]],"date-time":"2021-03-01T07:30:17Z","timestamp":1614583817000},"source":"Crossref","is-referenced-by-count":6,"title":["Successful neurosurgical separation of conjoined spinal cords in pygopagus twins: illustrative cases"],"prefix":"10.3171","volume":"1","author":[{"given":"Chisato","family":"Yokota","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery,"},{"name":"Department of Neurosurgery, Suita Municipal Hospital, Suita, Osaka, Japan; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naoki","family":"Kagawa","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yohei","family":"Bamba","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"},{"name":"Department of Neurosurgery, Iseikai Hospital, Higashi-yodogawaku, Osaka, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuko","family":"Tazuke","sequence":"additional","affiliation":[{"name":"Pediatric Surgery, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasuji","family":"Kitabatake","sequence":"additional","affiliation":[{"name":"Pediatrics, Osaka University Graduate School of Medicine, Suita, Osaka, Japan;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomoyoshi","family":"Nakagawa","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryuichi","family":"Hirayama","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroomi","family":"Okuyama","sequence":"additional","affiliation":[{"name":"Pediatric Surgery, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haruhiko","family":"Kishima","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Prenat Diagn","doi-asserted-by":"publisher","first-page":"814","DOI":"10.1002\/pd.1268","article-title":"Conjoined twins","volume":"25","author":"Spitz L","year":"2005","unstructured":"Spitz L. Conjoined twins. Prenat Diagn. 2005;25:814\u2013819.10.1002\/pd.1268"},{"issue":"4","key":"b2","series-title":"Ann R Coll Surg Engl","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1308\/003588403766274917","article-title":"Surgery for conjoined twins","volume":"85","author":"Spitz L","year":"2003","unstructured":"Spitz L. Surgery for conjoined twins. Ann R Coll Surg Engl. 2003;85(4):230\u2013235.10.1308\/003588403766274917"},{"issue":"5","key":"b3","series-title":"Surgery","doi-asserted-by":"publisher","first-page":"854","DOI":"10.1016\/j.surg.2019.06.028","article-title":"Predictors of in-hospital mortality in newborn conjoined twins","volume":"166","author":"Willobee BA","year":"2019","unstructured":"Willobee BA, Mulder M, Perez EA, . Predictors of in-hospital mortality in newborn conjoined twins. Surgery. 2019;166(5):854\u2013860.10.1016\/j.surg.2019.06.028"},{"issue":"4","key":"b4","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"699","DOI":"10.1007\/s00381-012-2007-2","article-title":"Separation surgery of pygopagus asymmetrical conjoined twins sharing U-shaped spinal cord: case report and literature review","volume":"29","author":"Hirokazu T","year":"2013","unstructured":"Hirokazu T, Takayuki I, Yoshinori H, . Separation surgery of pygopagus asymmetrical conjoined twins sharing U-shaped spinal cord: case report and literature review. Childs Nerv Syst. 2013;29(4):699\u2013706.10.1007\/s00381-012-2007-2"},{"issue":"suppl 4","key":"b5","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"S560","DOI":"10.1007\/s00586-014-3707-y","article-title":"Surgical management of pygopagus conjoined twins with spinal bifida","volume":"24","author":"Awasthi R","year":"2015","unstructured":"Awasthi R, Iyengar R, Rege S, Jain N. Surgical management of pygopagus conjoined twins with spinal bifida. Eur Spine J. 2015;24(suppl 4):S560\u2013S563.10.1007\/s00586-014-3707-y"},{"issue":"8-9","key":"b6","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"635","DOI":"10.1007\/s00381-004-0984-5","article-title":"Management of pyopagus conjoined twins","volume":"20","author":"Hockley AD","year":"2004","unstructured":"Hockley AD, Gornall P, Walsh R, . Management of pyopagus conjoined twins. Childs Nerv Syst. 2004;20(8-9):635\u2013639.10.1007\/s00381-004-0984-5"},{"issue":"9","key":"b7","series-title":"J Clin Neurosci","doi-asserted-by":"publisher","first-page":"968","DOI":"10.1016\/j.jocn.2005.11.038","article-title":"Separation of pyopagus conjoined twins: a New Zealand neurosurgical experience","volume":"13","author":"Winder M","year":"2006","unstructured":"Winder M, Law A. Separation of pyopagus conjoined twins: a New Zealand neurosurgical experience. J Clin Neurosci. 2006;13(9):968\u2013975.10.1016\/j.jocn.2005.11.038"},{"issue":"3","key":"b8","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1007\/s00381-002-0712-y","article-title":"Spinal cord involvement in pygopagus conjoined twins: case report and review of the literature","volume":"19","author":"Fieggen G","year":"2003","unstructured":"Fieggen G, Millar A, Rode H, . Spinal cord involvement in pygopagus conjoined twins: case report and review of the literature. Childs Nerv Syst. 2003;19(3):183\u2013187.10.1007\/s00381-002-0712-y"},{"issue":"4","key":"b9","series-title":"J Pediatr Surg","doi-asserted-by":"publisher","first-page":"619","DOI":"10.1016\/S0022-3468(99)90088-X","article-title":"Separation of complex pygopagus conjoined twins","volume":"34","author":"Fowler CL","year":"1999","unstructured":"Fowler CL, Pulito AR, Warf BC, Vandenbrink KD. Separation of complex pygopagus conjoined twins. J Pediatr Surg. 1999;34(4):619\u2013622.10.1016\/S0022-3468(99)90088-X"},{"issue":"2","key":"b10","series-title":"J Clin Neurophysiol","doi-asserted-by":"publisher","first-page":"e5","DOI":"10.1097\/WNP.0000000000000343","article-title":"Pygopagus conjoined twins: a neurophysiologic intraoperative monitoring schema","volume":"34","author":"Cromeens BP","year":"2017","unstructured":"Cromeens BP, McKinney JL, Leonard JR, . Pygopagus conjoined twins: a neurophysiologic intraoperative monitoring schema. J Clin Neurophysiol. 2017;34(2):e5\u2013e8.10.1097\/WNP.0000000000000343"},{"issue":"3","key":"b11","series-title":"Cold Spring Harb Perspect Biol","doi-asserted-by":"publisher","first-page":"a001735","DOI":"10.1101\/cshperspect.a001735","article-title":"Motor axon pathfinding","volume":"2","author":"Bonanomi D","year":"2010","unstructured":"Bonanomi D, Pfaff SL. Motor axon pathfinding. Cold Spring Harb Perspect Biol. 2010;2(3):a001735.10.1101\/cshperspect.a001735"},{"issue":"1","key":"b12","series-title":"J Anat","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1046\/j.1469-7580.2003.00131.x","article-title":"The innervation of FGF-induced additional limbs in the chick embryo","volume":"202","author":"Turney BW","year":"2003","unstructured":"Turney BW, Rowan-Hull AM, Brown JM. The innervation of FGF-induced additional limbs in the chick embryo. J Anat. 2003;202(1):83\u201392.10.1046\/j.1469-7580.2003.00131.x"},{"key":"b1","series-title":"Prenat Diagn","doi-asserted-by":"publisher","first-page":"814","DOI":"10.1002\/pd.1268","article-title":"Conjoined twins","volume":"25","author":"Spitz L","year":"2005","unstructured":"Spitz L. Conjoined twins. Prenat Diagn. 2005;25:814\u2013819.10.1002\/pd.1268"},{"issue":"4","key":"b2","series-title":"Ann R Coll Surg Engl","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1308\/003588403766274917","article-title":"Surgery for conjoined twins","volume":"85","author":"Spitz L","year":"2003","unstructured":"Spitz L. Surgery for conjoined twins. Ann R Coll Surg Engl. 2003;85(4):230\u2013235.10.1308\/003588403766274917"},{"issue":"5","key":"b3","series-title":"Surgery","doi-asserted-by":"publisher","first-page":"854","DOI":"10.1016\/j.surg.2019.06.028","article-title":"Predictors of in-hospital mortality in newborn conjoined twins","volume":"166","author":"Willobee BA","year":"2019","unstructured":"Willobee BA, Mulder M, Perez EA, . Predictors of in-hospital mortality in newborn conjoined twins. Surgery. 2019;166(5):854\u2013860.10.1016\/j.surg.2019.06.028"},{"issue":"4","key":"b4","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"699","DOI":"10.1007\/s00381-012-2007-2","article-title":"Separation surgery of pygopagus asymmetrical conjoined twins sharing U-shaped spinal cord: case report and literature review","volume":"29","author":"Hirokazu T","year":"2013","unstructured":"Hirokazu T, Takayuki I, Yoshinori H, . Separation surgery of pygopagus asymmetrical conjoined twins sharing U-shaped spinal cord: case report and literature review. Childs Nerv Syst. 2013;29(4):699\u2013706.10.1007\/s00381-012-2007-2"},{"issue":"suppl 4","key":"b5","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"S560","DOI":"10.1007\/s00586-014-3707-y","article-title":"Surgical management of pygopagus conjoined twins with spinal bifida","volume":"24","author":"Awasthi R","year":"2015","unstructured":"Awasthi R, Iyengar R, Rege S, Jain N. Surgical management of pygopagus conjoined twins with spinal bifida. Eur Spine J. 2015;24(suppl 4):S560\u2013S563.10.1007\/s00586-014-3707-y"},{"issue":"8-9","key":"b6","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"635","DOI":"10.1007\/s00381-004-0984-5","article-title":"Management of pyopagus conjoined twins","volume":"20","author":"Hockley AD","year":"2004","unstructured":"Hockley AD, Gornall P, Walsh R, . Management of pyopagus conjoined twins. Childs Nerv Syst. 2004;20(8-9):635\u2013639.10.1007\/s00381-004-0984-5"},{"issue":"9","key":"b7","series-title":"J Clin Neurosci","doi-asserted-by":"publisher","first-page":"968","DOI":"10.1016\/j.jocn.2005.11.038","article-title":"Separation of pyopagus conjoined twins: a New Zealand neurosurgical experience","volume":"13","author":"Winder M","year":"2006","unstructured":"Winder M, Law A. Separation of pyopagus conjoined twins: a New Zealand neurosurgical experience. J Clin Neurosci. 2006;13(9):968\u2013975.10.1016\/j.jocn.2005.11.038"},{"issue":"3","key":"b8","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1007\/s00381-002-0712-y","article-title":"Spinal cord involvement in pygopagus conjoined twins: case report and review of the literature","volume":"19","author":"Fieggen G","year":"2003","unstructured":"Fieggen G, Millar A, Rode H, . Spinal cord involvement in pygopagus conjoined twins: case report and review of the literature. Childs Nerv Syst. 2003;19(3):183\u2013187.10.1007\/s00381-002-0712-y"},{"issue":"4","key":"b9","series-title":"J Pediatr Surg","doi-asserted-by":"publisher","first-page":"619","DOI":"10.1016\/S0022-3468(99)90088-X","article-title":"Separation of complex pygopagus conjoined twins","volume":"34","author":"Fowler CL","year":"1999","unstructured":"Fowler CL, Pulito AR, Warf BC, Vandenbrink KD. Separation of complex pygopagus conjoined twins. J Pediatr Surg. 1999;34(4):619\u2013622.10.1016\/S0022-3468(99)90088-X"},{"issue":"2","key":"b10","series-title":"J Clin Neurophysiol","doi-asserted-by":"publisher","first-page":"e5","DOI":"10.1097\/WNP.0000000000000343","article-title":"Pygopagus conjoined twins: a neurophysiologic intraoperative monitoring schema","volume":"34","author":"Cromeens BP","year":"2017","unstructured":"Cromeens BP, McKinney JL, Leonard JR, . Pygopagus conjoined twins: a neurophysiologic intraoperative monitoring schema. J Clin Neurophysiol. 2017;34(2):e5\u2013e8.10.1097\/WNP.0000000000000343"},{"issue":"3","key":"b11","series-title":"Cold Spring Harb Perspect Biol","doi-asserted-by":"publisher","first-page":"a001735","DOI":"10.1101\/cshperspect.a001735","article-title":"Motor axon pathfinding","volume":"2","author":"Bonanomi D","year":"2010","unstructured":"Bonanomi D, Pfaff SL. Motor axon pathfinding. Cold Spring Harb Perspect Biol. 2010;2(3):a001735.10.1101\/cshperspect.a001735"},{"issue":"1","key":"b12","series-title":"J Anat","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1046\/j.1469-7580.2003.00131.x","article-title":"The innervation of FGF-induced additional limbs in the chick embryo","volume":"202","author":"Turney BW","year":"2003","unstructured":"Turney BW, Rowan-Hull AM, Brown JM. The innervation of FGF-induced additional limbs in the chick embryo. J Anat. 2003;202(1):83\u201392.10.1046\/j.1469-7580.2003.00131.x"}],"container-title":["Journal of Neurosurgery: Case Lessons"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/1\/9\/article-CASE218.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/1\/9\/article-CASE218.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/1\/9\/article-CASE218.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T14:56:42Z","timestamp":1770303402000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/1\/9\/article-CASE218.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,1]]},"references-count":24,"journal-issue":{"issue":"9"},"URL":"https:\/\/doi.org\/10.3171\/case218","relation":{},"ISSN":["2694-1902"],"issn-type":[{"value":"2694-1902","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3,1]]}}}