Missed limited dorsal myeloschisis: an unfortunate cause for recurrent tethered cord syndrome

This study aims to highlight the recurrent tethered cord syndrome in relation to the relatively new pathological entity of limited dorsal myeloschisis (LDM) and to mention the difficulties faced by the paediatric neurosurgeon in developing countries with reference to LDM which was not recognized at initial presentation. We present three cases of recurrent tethered cord syndrome who were operated early in life (not by paediatric neurosurgeons) as meningoceles and who were then subsequently referred to the senior author as they presented with clinical signs of re-tethering of the cord. The first child of 1 year of age represented with cervicodorsal swelling 10 months after primary surgery for a cervical meningomyelocele done elsewhere on the second day of life. The second was a girl of 3 years of age who was operated at birth and presented with severe brachialgia and neck pain after 2 years. The third was a 19-year-old girl operated at birth presenting with spastic paraparesis and also hand weakness associated with kyphosis. All the three patients improved symptomatically and neurologically after redo surgery. The diagnosis of LDMs, especially in developing countries, is frequently missed. This needs to be tackled and addressed so that children with this subset of neural tube defects, who otherwise would normally have a very good outcome, may not be blighted and left scarred for life at an early age.