Split cord malformation is a congenital condition that varies in form and severity, primarily diagnosed in pediatric patients. Surgical treatment is the most common method of correction. Herein, we discuss an extremely rare case of a split cord malformation associated with a midline cervical rib. A 49-year-old male patient presented to the emergency department with cervical spine trauma. MRI and CT scans were performed of the patient, revealing an unknown cervical rib structure and underlying split cord malformation. To our knowledge, this is the first report of an anomalous midline cervical rib related to a split cord malformation. Such a finding should prompt the clinician to further evaluate such a patient for underlying congenital occult spinal dysraphism such as split cord malformation. •We present a rare case where a 49-year-old patient’s SCM was associated with a rib-like structure that then contributed to a bony septum.•Neurological deficit should not be the only factor used to consider SCM and findings of routine imaging should be considered.•A clinician who manages patients should consider this rare morphology and avoid excessive manipulation which could injure an underlying SCM.