Adult-onset presentation of cervicothoracic split cord malformation: illustrative case

BACKGROUND: A 60-year-old female presented with a 6-month history of progressive lower limb pain, weakness, and declining mobility. She was initially diagnosed as having possible hip osteoarthritis or ligamental knee injury. She was eventually seen by a neurologist, who admitted her to a tertiary hospital with new-onset upper motor neuron signs and urinary incontinence. Magnetic resonance imaging of the whole spine revealed evidence of C7–T2 type 1 split cord malformation (SCM) necessitating urgent spinal surgery. She had an excellent outcome with intensive rehabilitation and returned to her premorbid level of function and mobility. OBSERVATIONS: The patient presented with nonspecific symptoms, which led to multiple referrals and a significant delay in her diagnosis. LESSONS: Clinicians should be aware of the importance of a detailed history with thorough neurological and spinal examinations.