{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T16:07:52Z","timestamp":1776096472632,"version":"3.50.1"},"reference-count":38,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","license":[{"start":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T00:00:00Z","timestamp":1769990400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2026,2,2]]},"abstract":"\n BACKGROUND<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n 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\u201311 nonsegmented unilateral bar, resulting in thoracolumbar levoscoliosis (maximal Cobb angle of 49\u00b0). 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\u00b0. The patient then underwent a second-stage T2\u2013L3 posterior lateral fixation and fusion with a pedicle screw-rod construction. The postoperative curve magnitude was 25.2\u00b0. Five years following operation, she required no revision surgery and remained neurologically intact.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n 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.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE25315<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case25315","type":"journal-article","created":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T13:30:01Z","timestamp":1770298201000},"source":"Crossref","is-referenced-by-count":0,"title":["Surgical fixation of a unilateral bar and unsegmented butterfly vertebra in a patient with diastematomyelia and a tethered cord: illustrative case"],"prefix":"10.3171","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7238-5665","authenticated-orcid":true,"given":"Luke","family":"Mugge","sequence":"first","affiliation":[{"name":"Department of Neurosciences, Inova Neuroscience and Spine Institute, Falls Church, Virginia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Duy","family":"Pham","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Inova Neuroscience and Spine Institute, Falls Church, Virginia"},{"name":"University of Virginia School of Medicine, Charlottesville, Virginia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aqib","family":"Zehri","sequence":"additional","affiliation":[{"name":"The Oregon Clinic, Department of Neurosurgery and Spine, Portland, Oregon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Danielle","family":"Dang","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Inova Neuroscience and Spine Institute, Falls Church, Virginia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-1714-2497","authenticated-orcid":true,"given":"Cristie","family":"Brewer","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Inova Neuroscience and Spine Institute, Falls Church, Virginia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peggy","family":"Vollstad","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Inova Neuroscience and Spine Institute, Falls Church, Virginia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leon E.","family":"Moores","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Inova Neuroscience and Spine Institute, Falls Church, Virginia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian","family":"McHugh","sequence":"additional","affiliation":[{"name":"Long Island Brain and Spine, West Islip, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"6","key":"bib1","series-title":"Spine (Phila Pa 1976)","first-page":"E344","article-title":"Diastematomyelia: a 35-year experience","volume":"38","author":"Huang","year":"2013","unstructured":"Huang SLHe XJWang KZLan BS.Diastematomyelia: a 35-year experience. Spine (Phila Pa 1976). 2013;38(6):E344-E349."},{"issue":"2","key":"bib2","series-title":"J Neurosurg Spine","first-page":"231","article-title":"Thoracic diastematomyelia with concurrent intradural epidermoid spinal cord tumor and cervical syrinx in an adult: case report","volume":"97","author":"Sheehan","year":"2002","unstructured":"Sheehan JPSheehan JMLopes MBJane JA.Thoracic diastematomyelia with concurrent intradural epidermoid spinal cord tumor and cervical syrinx in an adult: case report. J Neurosurg Spine. 2002;97(2)(suppl):231-234."},{"issue":"1","key":"bib3","series-title":"Asian Spine J","first-page":"99","article-title":"Diastematomyelia: a surgical case with long-term follow-up","volume":"9","author":"Bekki","year":"2015","unstructured":"Bekki HMorishita YKawano OShiba KIwamoto Y.Diastematomyelia: a surgical case with long-term follow-up. Asian Spine J. 2015;9(1):99-102."},{"issue":"5","key":"bib4","series-title":"Childs Nerv Syst","first-page":"515","article-title":"Diastematomyelia in children: treatment outcome and natural history of associated syringomyelia","volume":"23","author":"Gan","year":"2007","unstructured":"Gan YCSgouros SWalsh ARHockley AD.Diastematomyelia in children: treatment outcome and natural history of associated syringomyelia. Childs Nerv Syst. 2007;23(5):515-519."},{"issue":"3","key":"bib5","series-title":"Neurosurgery","first-page":"451","article-title":"Split cord malformation: part I: a unified theory of embryogenesis for double spinal cord malformations","volume":"31","author":"Pang","year":"1992","unstructured":"Pang DDias MSAhab-Barmada M.Split cord malformation: part I: a unified theory of embryogenesis for double spinal cord malformations. Neurosurgery. 1992;31(3):451-480."},{"issue":"6","key":"bib6","series-title":"J Neurosurg Pediatr","first-page":"531","article-title":"Split cord malformations: a clinical study of 254 patients and a proposal for a new clinical\u2014imaging classification","volume":"103","author":"Mahapatra","year":"2005","unstructured":"Mahapatra AKGupta DK.Split cord malformations: a clinical study of 254 patients and a proposal for a new clinical\u2014imaging classification. J Neurosurg Pediatr. 2005;103(6)(suppl):531-536."},{"issue":"3","key":"bib7","series-title":"Eur Spine J","first-page":"498","article-title":"Surgical treatment of severe congenital scoliosis with unilateral unsegmented bar by concave costovertebral joint release and both-ends wedge osteotomy via posterior approach","volume":"21","author":"Li","year":"2012","unstructured":"Li CFu QZhou YYu HZhao G.Surgical treatment of severe congenital scoliosis with unilateral unsegmented bar by concave costovertebral joint release and both-ends wedge osteotomy via posterior approach. Eur Spine J. 2012;21(3):498-505."},{"issue":"11","key":"bib8","series-title":"J Bone Joint Surg Am","first-page":"972","article-title":"Prognosis for congenital scoliosis due to a unilateral failure of vertebral segmentation","volume":"95","author":"McMaster","year":"2013","unstructured":"McMaster MJMcMaster ME.Prognosis for congenital scoliosis due to a unilateral failure of vertebral segmentation. J Bone Joint Surg Am. 2013;95(11):972-979."},{"issue":"10","key":"bib9","series-title":"J Bone Joint Surg Br","first-page":"1380","article-title":"Combined diastematomyelia and hemivertebra: a review of the management at a single centre","volume":"87","author":"Leung","year":"2005","unstructured":"Leung YLBuxton N.Combined diastematomyelia and hemivertebra: a review of the management at a single centre. J Bone Joint Surg Br. 2005;87(10):1380-1384."},{"issue":"16","key":"bib10","series-title":"Spine (Phila Pa 1976)","first-page":"1310","article-title":"Clinical outcomes of different surgical strategy for patients with congenital scoliosis and Type I split cord malformation","volume":"41","author":"Feng","year":"2016","unstructured":"Feng FShen JZhang JClinical outcomes of different surgical strategy for patients with congenital scoliosis and Type I split cord malformation. Spine (Phila Pa 1976). 2016;41(16):1310-1316."},{"issue":"1","key":"bib11","series-title":"Childs Nerv Syst","first-page":"163","article-title":"Treatment of spinal deformity with diastematomyelia type I: one-stage, two-stage surgery and new technique (vertebral column resection through wide bony septum)","volume":"38","author":"Sergeenko Pavlova","year":"2022","unstructured":"Sergeenko Pavlova OMSavin DMRyabykh SO.Treatment of spinal deformity with diastematomyelia type I: one-stage, two-stage surgery and new technique (vertebral column resection through wide bony septum). Childs Nerv Syst. 2022;38(1):163-172."},{"issue":"22","key":"bib12","series-title":"Spine (Phila Pa 1976)","first-page":"2413","article-title":"Is it necessary to operate all split cord malformations before corrective surgery for patients with congenital spinal deformities?","volume":"34","author":"Ayvaz","year":"2009","unstructured":"Ayvaz MAkalan NYazici MAlanay AAcaroglu RE.Is it necessary to operate all split cord malformations before corrective surgery for patients with congenital spinal deformities? Spine (Phila Pa 1976). 2009;34(22):2413-2418."},{"issue":"1","key":"bib13","series-title":"Spinal Cord Ser Cases","first-page":"109","article-title":"Diagnosis and treatment of diastematomyelia in children: a perspective cohort study","volume":"4","author":"Vissarionov","year":"2018","unstructured":"Vissarionov SVKrutelev NASnischuk VPDiagnosis and treatment of diastematomyelia in children: a perspective cohort study. Spinal Cord Ser Cases. 2018;4(1):109."},{"issue":"4","key":"bib14","series-title":"J Bone Joint Surg Am","first-page":"456","article-title":"Progression of congenital scoliosis due to hemivertebrae and hemivertebrae with bars","volume":"57","author":"Nasca","year":"1975","unstructured":"Nasca RJStilling FHStell HH.Progression of congenital scoliosis due to hemivertebrae and hemivertebrae with bars. J Bone Joint Surg Am. 1975;57(4):456-466."},{"issue":"24","key":"bib15","series-title":"J Bone Joint Surg Am","first-page":"2096","article-title":"Characteristics and clinical relevance of the osseous spur in patients with congenital scoliosis and split spinal cord malformation","volume":"98","author":"Feng","year":"2016","unstructured":"Feng FShen JZhang JLi SYu KTan H.Characteristics and clinical relevance of the osseous spur in patients with congenital scoliosis and split spinal cord malformation. J Bone Joint Surg Am. 2016;98(24):2096-2102."},{"issue":"3","key":"bib16","series-title":"J Surg Case Rep","first-page":"rjae153","article-title":"Correction of a congenital kyphoscoliosis associated with diastematomyelia","volume":"2024","author":"Abdaliyev","year":"2024","unstructured":"Abdaliyev SYestay DBaitov D.Correction of a congenital kyphoscoliosis associated with diastematomyelia. J Surg Case Rep. 2024;2024(3):rjae153."},{"issue":"suppl 2","key":"bib17","series-title":"Eur Spine J","first-page":"262","article-title":"Diastematomyelia in congenital scoliosis: a report of two cases","volume":"23","author":"Gavriliu","year":"2014","unstructured":"Gavriliu SVlad CGeorgescu IBurnei G.Diastematomyelia in congenital scoliosis: a report of two cases. Eur Spine J. 2014;23(suppl 2):262-266."},{"issue":"5","key":"bib18","series-title":"SN Compr Clin Med","first-page":"1241","article-title":"Exotic congenital scoliosis with diastematomyelia: two case reports","volume":"3","author":"Simion","year":"2021","unstructured":"Simion CTarnoveanu SJapie EMGhita RAGavriliu SSpataru RI.Exotic congenital scoliosis with diastematomyelia: two case reports. SN Compr Clin Med. 2021;3(5):1241-1245."},{"issue":"1","key":"bib19","series-title":"Coluna\/Columna","first-page":"64","article-title":"Study design: case series of 10 patients operated for severe scoliosis and diastematomyelia","volume":"18","author":"Mikhaylovskiy","year":"2019","unstructured":"Mikhaylovskiy MVDubousset JNovikov VVVasyura ASUdalova IGSadovoi MA.Study design: case series of 10 patients operated for severe scoliosis and diastematomyelia. Coluna\/Columna. 2019;18(1):64-69."},{"issue":"6","key":"bib1","series-title":"Spine (Phila Pa 1976)","first-page":"E344","article-title":"Diastematomyelia: a 35-year experience","volume":"38","author":"Huang","year":"2013","unstructured":"Huang SLHe XJWang KZLan BS.Diastematomyelia: a 35-year experience. Spine (Phila Pa 1976). 2013;38(6):E344-E349."},{"issue":"2","key":"bib2","series-title":"J Neurosurg Spine","first-page":"231","article-title":"Thoracic diastematomyelia with concurrent intradural epidermoid spinal cord tumor and cervical syrinx in an adult: case report","volume":"97","author":"Sheehan","year":"2002","unstructured":"Sheehan JPSheehan JMLopes MBJane JA.Thoracic diastematomyelia with concurrent intradural epidermoid spinal cord tumor and cervical syrinx in an adult: case report. J Neurosurg Spine. 2002;97(2)(suppl):231-234."},{"issue":"1","key":"bib3","series-title":"Asian Spine J","first-page":"99","article-title":"Diastematomyelia: a surgical case with long-term follow-up","volume":"9","author":"Bekki","year":"2015","unstructured":"Bekki HMorishita YKawano OShiba KIwamoto Y.Diastematomyelia: a surgical case with long-term follow-up. Asian Spine J. 2015;9(1):99-102."},{"issue":"5","key":"bib4","series-title":"Childs Nerv Syst","first-page":"515","article-title":"Diastematomyelia in children: treatment outcome and natural history of associated syringomyelia","volume":"23","author":"Gan","year":"2007","unstructured":"Gan YCSgouros SWalsh ARHockley AD.Diastematomyelia in children: treatment outcome and natural history of associated syringomyelia. Childs Nerv Syst. 2007;23(5):515-519."},{"issue":"3","key":"bib5","series-title":"Neurosurgery","first-page":"451","article-title":"Split cord malformation: part I: a unified theory of embryogenesis for double spinal cord malformations","volume":"31","author":"Pang","year":"1992","unstructured":"Pang DDias MSAhab-Barmada M.Split cord malformation: part I: a unified theory of embryogenesis for double spinal cord malformations. Neurosurgery. 1992;31(3):451-480."},{"issue":"6","key":"bib6","series-title":"J Neurosurg Pediatr","first-page":"531","article-title":"Split cord malformations: a clinical study of 254 patients and a proposal for a new clinical\u2014imaging classification","volume":"103","author":"Mahapatra","year":"2005","unstructured":"Mahapatra AKGupta DK.Split cord malformations: a clinical study of 254 patients and a proposal for a new clinical\u2014imaging classification. J Neurosurg Pediatr. 2005;103(6)(suppl):531-536."},{"issue":"3","key":"bib7","series-title":"Eur Spine J","first-page":"498","article-title":"Surgical treatment of severe congenital scoliosis with unilateral unsegmented bar by concave costovertebral joint release and both-ends wedge osteotomy via posterior approach","volume":"21","author":"Li","year":"2012","unstructured":"Li CFu QZhou YYu HZhao G.Surgical treatment of severe congenital scoliosis with unilateral unsegmented bar by concave costovertebral joint release and both-ends wedge osteotomy via posterior approach. Eur Spine J. 2012;21(3):498-505."},{"issue":"11","key":"bib8","series-title":"J Bone Joint Surg Am","first-page":"972","article-title":"Prognosis for congenital scoliosis due to a unilateral failure of vertebral segmentation","volume":"95","author":"McMaster","year":"2013","unstructured":"McMaster MJMcMaster ME.Prognosis for congenital scoliosis due to a unilateral failure of vertebral segmentation. J Bone Joint Surg Am. 2013;95(11):972-979."},{"issue":"10","key":"bib9","series-title":"J Bone Joint Surg Br","first-page":"1380","article-title":"Combined diastematomyelia and hemivertebra: a review of the management at a single centre","volume":"87","author":"Leung","year":"2005","unstructured":"Leung YLBuxton N.Combined diastematomyelia and hemivertebra: a review of the management at a single centre. J Bone Joint Surg Br. 2005;87(10):1380-1384."},{"issue":"16","key":"bib10","series-title":"Spine (Phila Pa 1976)","first-page":"1310","article-title":"Clinical outcomes of different surgical strategy for patients with congenital scoliosis and Type I split cord malformation","volume":"41","author":"Feng","year":"2016","unstructured":"Feng FShen JZhang JClinical outcomes of different surgical strategy for patients with congenital scoliosis and Type I split cord malformation. Spine (Phila Pa 1976). 2016;41(16):1310-1316."},{"issue":"1","key":"bib11","series-title":"Childs Nerv Syst","first-page":"163","article-title":"Treatment of spinal deformity with diastematomyelia type I: one-stage, two-stage surgery and new technique (vertebral column resection through wide bony septum)","volume":"38","author":"Sergeenko Pavlova","year":"2022","unstructured":"Sergeenko Pavlova OMSavin DMRyabykh SO.Treatment of spinal deformity with diastematomyelia type I: one-stage, two-stage surgery and new technique (vertebral column resection through wide bony septum). Childs Nerv Syst. 2022;38(1):163-172."},{"issue":"22","key":"bib12","series-title":"Spine (Phila Pa 1976)","first-page":"2413","article-title":"Is it necessary to operate all split cord malformations before corrective surgery for patients with congenital spinal deformities?","volume":"34","author":"Ayvaz","year":"2009","unstructured":"Ayvaz MAkalan NYazici MAlanay AAcaroglu RE.Is it necessary to operate all split cord malformations before corrective surgery for patients with congenital spinal deformities? Spine (Phila Pa 1976). 2009;34(22):2413-2418."},{"issue":"1","key":"bib13","series-title":"Spinal Cord Ser Cases","first-page":"109","article-title":"Diagnosis and treatment of diastematomyelia in children: a perspective cohort study","volume":"4","author":"Vissarionov","year":"2018","unstructured":"Vissarionov SVKrutelev NASnischuk VPDiagnosis and treatment of diastematomyelia in children: a perspective cohort study. Spinal Cord Ser Cases. 2018;4(1):109."},{"issue":"4","key":"bib14","series-title":"J Bone Joint Surg Am","first-page":"456","article-title":"Progression of congenital scoliosis due to hemivertebrae and hemivertebrae with bars","volume":"57","author":"Nasca","year":"1975","unstructured":"Nasca RJStilling FHStell HH.Progression of congenital scoliosis due to hemivertebrae and hemivertebrae with bars. J Bone Joint Surg Am. 1975;57(4):456-466."},{"issue":"24","key":"bib15","series-title":"J Bone Joint Surg Am","first-page":"2096","article-title":"Characteristics and clinical relevance of the osseous spur in patients with congenital scoliosis and split spinal cord malformation","volume":"98","author":"Feng","year":"2016","unstructured":"Feng FShen JZhang JLi SYu KTan H.Characteristics and clinical relevance of the osseous spur in patients with congenital scoliosis and split spinal cord malformation. J Bone Joint Surg Am. 2016;98(24):2096-2102."},{"issue":"3","key":"bib16","series-title":"J Surg Case Rep","first-page":"rjae153","article-title":"Correction of a congenital kyphoscoliosis associated with diastematomyelia","volume":"2024","author":"Abdaliyev","year":"2024","unstructured":"Abdaliyev SYestay DBaitov D.Correction of a congenital kyphoscoliosis associated with diastematomyelia. J Surg Case Rep. 2024;2024(3):rjae153."},{"issue":"suppl 2","key":"bib17","series-title":"Eur Spine J","first-page":"262","article-title":"Diastematomyelia in congenital scoliosis: a report of two cases","volume":"23","author":"Gavriliu","year":"2014","unstructured":"Gavriliu SVlad CGeorgescu IBurnei G.Diastematomyelia in congenital scoliosis: a report of two cases. Eur Spine J. 2014;23(suppl 2):262-266."},{"issue":"5","key":"bib18","series-title":"SN Compr Clin Med","first-page":"1241","article-title":"Exotic congenital scoliosis with diastematomyelia: two case reports","volume":"3","author":"Simion","year":"2021","unstructured":"Simion CTarnoveanu SJapie EMGhita RAGavriliu SSpataru RI.Exotic congenital scoliosis with diastematomyelia: two case reports. SN Compr Clin Med. 2021;3(5):1241-1245."},{"issue":"1","key":"bib19","series-title":"Coluna\/Columna","first-page":"64","article-title":"Study design: case series of 10 patients operated for severe scoliosis and diastematomyelia","volume":"18","author":"Mikhaylovskiy","year":"2019","unstructured":"Mikhaylovskiy MVDubousset JNovikov VVVasyura ASUdalova IGSadovoi MA.Study design: case series of 10 patients operated for severe scoliosis and diastematomyelia. Coluna\/Columna. 2019;18(1):64-69."}],"container-title":["Journal of Neurosurgery: Case Lessons"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/11\/5\/article-CASE25315.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/11\/5\/article-CASE25315.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/11\/5\/article-CASE25315.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T15:27:09Z","timestamp":1776094029000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/11\/5\/article-CASE25315.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,2]]},"references-count":38,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.3171\/case25315","relation":{},"ISSN":["2694-1902"],"issn-type":[{"value":"2694-1902","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,2]]}}}