Cervical and thoracic dermal sinus tracts. A case series and review of the literature.

Cervical and thoracic dermal sinus tracts (DSTs) account for 1 and 10%, respectively, of all DSTs. Few case reports describe this diagnosis. To characterize this entity, a 30-year retrospective audit was utilized to identify cases. Nine cases were identified, five of which were cervical and four thoracic. Four cases less than 1 year old presented with skin findings and no neurologic deficit. All five cases greater than 1 year old presented with neurologic findings. Initial examination revealed changes in motor function (n = 5), sensation (n = 4), reflexes (n = 5), gait (n = 4) and altered bowel/bladder function (n = 2). Eight patients had cutaneous findings and 7 had bifid spinous processes overlying tract entry into the dura. Operative findings included 6 buckled tethered cords, opacified arachnoid or frank arachnoiditis in 4 patients, 2 tract CSF leaks, 2 split cord malformations and 2 intradural tumors. Mean follow-up was 36 months. All infants remained neurologically intact. Four of the 5 patients greater than 1 year old demonstrated improvement; 1 continued with a stable deficit. This series of cervical and thoracic DSTs highlights the need for close attention to skin lesions in infants and consideration of retethering or tumor in patients with previous resections who deteriorate. Definitive operation including intradural exploration should be performed with the initial operation in an attempt to obviate future complications.