Clinical Features of Post-Traumatic Syringomyelia

Abstract

ObjectiveThe purpose of this study was to analyze the clinical manifestations, radiological findings, treatment results, and clinical significance of post-traumatic syringomyelia (PTS).MethodsWe retrospectively reviewed the medical charts of nine surgical patients with symptomatic PTS between 1992 and 2012.ResultsThe most common clinical manifestation was development of new motor weakness. The mean interval between the initial injury and the onset of new symptoms 21.9 years. The mean length of the syringes observed on preoperative magnetic resonance images was 7.8 spinal levels. Shunting procedures were performed in five patients. Four patients underwent arachnoidolysis and duraplasty. Patients developed mechanical shunt failure. Postoperatively, one patient showed clinical improvement, four patients were stable, and four patients showed deterioration.ConclusionPTS is a disabling sequelae of spinal cord injury, which develops months to years after spinal injury. We have to consider that patients with PTS may have poor long-term outcome.

Multiple therapeutic effects of human neural stem cells derived from induced pluripotent stem cells in a rat model of post-traumatic syringomyelia

“…Post-traumatic syringomyelia (PTS) is a chronic complication of spinal cord injury (SCI), characterized by progressive intraspinal cyst formation and expansion months to years after primary injury. 1 With the increased use of magnetic resonance imaging (MRI) for diagnosis in the clinic the last two decades, the rate of diagnosed PTS in SCI patients has risen to 20À30% 2 but is still often an underestimated clinical problem. 3 The major symptoms are the aggravation of the already present functional impairment of movement, sensation and bowel or bladder control, and of other symptoms including neuropathic pain and spasticity.…”

Treatment of posttraumatic syringomyelia: evidence from a systematic review

“… 53% incomplete; 47% complete 6 levels (range 1–16) 100% arachnoid lysis+cord transsection 24 months 40% improved; 53% stable; 7% deteriorated No complication Cord transsection alternative option for progressive SM and adhesive arachnoitis Oluigbo [ 41 ]; observational; N = 5 n.a. 100% incomplete 40% cervical; 60% thoracic 100% surgery—80% decompression+lumbo-peritoneal shunt and 20% lumbo-peritoneal shunt 25 months 40% improved; 60% deteriorated; 60% MRI improved 60% shunt revision Lumbo-peritoneal drain indicated if no CSF obstruction visible Aghakhani [ 2 ]; observational; N = 34 133 months 100% incomplete 9% cervical; 70% thoracic; 21% lumbar 100% surgery—(A) 56% arachnoid lysis and (B) 44% drain (A) 84 months; (B) 46 months (A) 73% improved, 21% stable, and 5% deteriorated; (B) 47% stable and 53% deteriorated 68% complication—53% shunt revision, 9% CSF leak, 3% meningitis, and 3% pneumonia Early correction of spinal canal stenosis essential; subarachnoid space reconstruction and cyst opening is safe and effective Klekamp [ 31 ]; observational; N = 137 135 months 33% ASIA (A + B); 0% ASIA (C + D); 27% ASIA (E) 22% cervical; 66% thoracic; 12% lumbar 55% conservative ( N = 76); 45% surgery ( N = 61)—88% arachnoid lysis+duraplasty and 3% cord transection Conservative—67 months; surgery n.a. Conservative—67% stable; Surgery : ASIA (A + B)—65% improved and 35% stable; ASIA (C + D)—52% improved, 39% stable, and 9% deteriorated; ASIA E—38% improved, 50% stable, 13% deteriorated 16% complication, 13% revision, 8% neurological deficit (transient), 5% wound infection, 5% hematoma, 2% CSF leak, 2% cardiac arrest, 22% 5-year recurrence, and 56% 10-year recurrence Decompression with arachnolysis, untethering, and duraplasty provides good long-term results for patients with progressive neurological symptoms; Treatment of patients with preserved motor functions remains a major challenge Isik [ 27 ]; N = 19 24 months n.a.…”

Brachioradial Pruritus as a Harbinger of Syrinx in Chronic Spinal Cord Injury: A Case Report

“…The most common presenting symptom is weakness above the previous neurologic level of injury, with numbness and spasticity changes considered more minor symptoms. Surgery (syringo‐subarachnoid shunt or syringo‐pleural shunt) is considered in cases of severe weakness and concurrent arachnoiditis but has an associated morbidity related to shunt malfunctions and infection [9].…”