Neglected Posterior Cervical Myelomeningocele in Adults: Systematic Review of the Literature and Illustrative Case

Objectives: Adult posterior cervical spinal dysraphism, including meningocele (MC), myelomeningocele (MMC), and myelocystocele (MyCC) is exceptionally rare and remains insufficiently characterised. This study aimed to conduct the first systematic review of the literature on adult cases and report an additional illustrative case. Methods: A PRISMA 2020 systematic review of PubMed/MEDLINE, Web of Science and Scopus was conducted (PROSPERO CRD420261426944). Data were extracted at case level, grouped by the lesion label used by the original authors, and synthesised narratively. Results: Nineteen studies (18 case reports and one case series) described 23 adults (median age 24 years; 19 male): 16 MC, one MyCC and six MMC. An objective neurological abnormality was documented in 14 of 21 examined patients. Nineteen patients were operated on; among 17 with a classified outcome, ten improved, five were intact and two were stable, and none were reported worse (median follow-up 12 months). The additional case was a 62-year-old man with a radiologically diagnosed C4–C5 lesion most consistent with MMC and no objective neurological deficit, managed by observation (3 months of follow-up). Conclusions: The evidence is sparse, heterogeneous and prone to publication bias, and it is insufficient to establish natural history, optimal management or the relative merits of surgery and observation. Standardised terminology, multicentre registries and long-term follow-up are needed.