Split-Cord Malformation of the Cervical Spinal Cord Following Dorsal Root Entry Zone Lesioning Surgery

The authors report a rare case of a 54-year-old man who developed an asymptomatic cleft within the cervical spinal cord at C7-T1 following Dorsal Root Entry Zone (DREZ) lesioning surgery. The patient presented to the authors’ institution with neuropathic pain from a left brachial plexopathy resulting from a lower trunk avulsion. The initial MRI at 6 months post-injury confirmed preganglionic avulsions of the left C7, C8 and T1 nerve roots. Of note, there was a prominent anterior median fissure at the C7-T1 spinal level. He underwent a DREZ lesion 8 months after the injury. Subsequent MRI studies showed a progressive near complete split within the cervical cord at C7- T1. The patient did not develop any new neurological deficits. It remains unclear whether this observation was a sequela of the root avulsion or the DREZ surgery.