Understanding split cord malformation: from pathophysiology to long-term outcomes
Bibliographic record
Abstract
Split cord malformation (SCM) is a rare congenital anomaly of the spinal cord, frequently associated with tethered cord syndrome and orthopedic, urological, and neurological sequelae. Surgical management of SCM remains controversial, particularly regarding timing of intervention, selection criteria for asymptomatic cases, and expected outcomes for different SCM types. This systematic review aims to synthesize current evidence regarding surgical indications, techniques, outcomes, and prognostic factors in SCM treatment. We conducted a comprehensive systematic review of the literature, selecting 30 studies comprising over 1,200 patients who underwent surgery for SCM. Outcomes assessed included neurological, urological, and orthopedic status, complication rates, timing of surgery, and comparative outcomes between type I and type II SCM. Study quality was assessed using the Newcastle-Ottawa scale. Early surgical intervention, especially in type I SCM, was consistently associated with superior outcomes. Preoperative neurological status emerged as the strongest predictor of postoperative results, with early surgery preventing progression and facilitating functional improvement. Urological and orthopedic outcomes similarly benefited from timely intervention. Type II SCM demonstrated a more benign course, with selective surgical indications. Overall complication rates were low, with transient neurological worsening being the most common adverse event. Intraoperative neurophysiological monitoring contributed to enhanced surgical safety. Early surgical correction remains the cornerstone of SCM management, particularly in type I cases. Delayed intervention is associated with reduced potential for neurological recovery. Further prospective studies are needed to refine patient selection criteria, optimize long-term outcomes, and guide management of adult and type II SCM presentations.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.039 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.003 |
| Bibliometrics | 0.006 | 0.005 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".