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Background and objective: Globally, diastematomyelia accounts for 5% of all congenital spinal cord defects. Clinically, symptoms of diastematomyelia are non-specific, can be progressive, and can become symptomatic at any age. This study was carried out to describe neurological, radiological and surgical findings of diastematomyelia cases reported in Erbil city of Iraq. Methods: A retrospective review of diastematomyelia was carried out in three neurosurgical centers in Erbil city of Kurdistan region of Iraq between 1st January 2003 and 1st January 2013. Diagnosis of this anomaly was based on CT and MRI with surgical dissection in one case. In patients with contraindication for MRI and CT scan, the diagnosis was based on lumbar myelography. Surgical interventions included surgical decompression and laminectomy with timely follow-up at every six months to assess the outcomes after the surgical intervention. Results: A total of 27 cases were included in this study with a mean age of 13 years (ranging from 1-19 years) and a female to male ratio of 2.9:1. Spinal deformities (66.7 %) were the main complaints for patients to seek medical advice. Clinically, 89 % of the patients had a huge spinal disfigurement, and 74% had a mid-line thoracic or lumbar cutaneous variation from the norm. Neurologically, 59 % of the patients had a least neurological disability. Radiologically, 96 % showed inter-pedicular separation and spina bifida, 59% scoliosis, and 55.6% boney spicule. Intra-operatively, around 63% of the cases had boney septum separating the dissected hemi-cords; 70 % of the septa located in the lumbar region. Post-operatively, none of the patients experienced decay in their neurologic status after surgery. Over the long term, two patients were slightly improved, and another two had an increased neurological deficit, one patient had better reflexes, but increasing deformity of the foot and 14 patients were unchanged. None of the patients had contamination, pseudoarthrosis, or loss of remedy amid the subsequent visit. Conclusion: Despite the slight postoperative improvement, all patients with the established preoperative deficit still had residual neurological postoperative deficits and only a low proportion of them slightly improved.

Background: Degenerative changes in the intervertebral disc begin at the late teens and early adult life, after the completion of the physical growth and development. Lumbar disc herniation is rare in children and adolescents. The clinical presentation and etiology of lumber disc herniation may differ from that in adults. Objective: To determine the rate of lumber disc herniation among adolescents and to describe the radiological, clinical features and surgical outcomes of lumber disc herniation in a group of adolescent and young adult patients. Patients and Methods: A retrospective revision of 1045 cases of lumbar disc excisions performed at the neurosurgical unit of Erbil teaching hospital between 2001 and 2015 was done. In all cases, the diagnosis was achieved pre-operatively by lumbar spine MRI with or without CT scan. Initially all patients were treated conservatively for more than 3 months without success. The indications for surgery were failure of conservative treatment, intractable pain and/or progressive neurological impairment. Surgical posterior discectomy with fenestration or partial laminectomy or hemi-laminectomy was performed. On the day of discharge Kirkaldy-Willis criteria was used to assess the patient post-operatively. Results: Thirteen (1.22%) of the 1045 patients were adolescents and young adults between 13 and 21 years of age with a male: female ratio of 1.16: 1. Nearly 70 % of patients had a history of trauma. Lumbar back pain and radicular sciatica were the main complaints in 77% of the patients. Two patients had radicular leg pain. Only one patient of the 13 patients experienced lumbar back pain without leg pain. Only one patient was found to have neurological deficit with partial foot drop. Prior to surgical intervention, straight leg raising test was positive in all 13 patients. All of the patients had symptoms duration for more than 3 months. The radiological and surgical findings revealed a protruding disc in eleven cases, one lateral recess stenosis and one lumbar synovial cyst. Epiphyseal ring fracture was found in 4 of the 5 patients who underwent CT study. Results of Kirkaldy-Willis criteria were excellent or good in 92 % of patients. The follow-up period ranged from 4 months to 2 years with an average of 14 months. Conclusion: Young adults and adolescents disc herniation is uncommon and is often precipitated by trauma. Surgical treatment of such patients relieves clinical symptoms quickly and is associated with good and excellent results in nearly all patients.