Impact of cordectomy as a treatment option for posttraumatic and non-posttraumatic syringomyelia with tethered cord syndrome and myelopathy

Ewelt, Christian; Stalder, Susanne; Steiger, Hans‐Jakob; Hildebrandt, Gerhard; Heilbronner, Raoul

doi:10.3171/2010.3.spine0976

Cited by 18 publications

(5 citation statements)

References 13 publications

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“…3,11,15,17,24,28,39,42,50,53,54,57,66,67,76 When symptoms develop, they may involve pain, sensory changes, motor weakness, deteriorations of gait, autonomic dysfunctions, or increased spasticity. 3,12,16,18,39,42,54,76 Depending on the presence and severity of cord injury, the clinical course and the major concerns of the patients vary considerably.…”

Section: Clinical Presentationmentioning

confidence: 99%

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Treatment of posttraumatic syringomyelia

Klekamp¹

2012

SPI

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ObjectThis paper presents results of a prospective study for patients undergoing surgery for posttraumatic syringomyelia between 1991 and 2010.MethodsA group of 137 patients with posttraumatic syringomyelia were evaluated (mean age 45 ± 13 years, mean follow-up 51 ± 51 months) with pre- and postoperative MRI and clinical examinations presenting in this period and followed prospectively by outpatient visits and questionnaires. Surgery was recommended for symptomatic patients with a progressive course. Short-term results were determined within 3 months of surgery, whereas long-term outcomes in terms of clinical recurrences were studied with Kaplan-Meier statistics.ResultsThree groups were distinguished according to the type of trauma: Group A, patients with spinal trauma but without cord injury (ASIA E, n = 37); Group B, patients with an incomplete cord injury (ASIA C or D, n = 55); and Group C, patients with complete loss of motor function or a complete cord injury (ASIA A or B, n = 45). Overall, 61 patients with progressive symptoms underwent 71 operations. Of these operations, 61 consisted of arachnolysis, untethering, and duraplasty at the trauma level (that is, decompression), while 4 ASIA A patients underwent a cordectomy. The remaining procedures consisted of placement of a thecoperitoneal shunt, 2 opiate pump placements, and 2 anterior and 1 posterior cervical decompression and fusion. Seventy-six patients were not treated surgically due to lack of neurological progression or refusal of an operation. Neurological symptoms remained stable for 10 years in 84% of the patients for whom surgery was not recommended due to lack of neurological progression. In contrast, 60% of those who declined recommended surgery had neurological progression within 5 years. For patients presenting with neurological progression, outcome was better with decompression. Postoperatively, 61% demonstrated a reduction of syrinx size. Although neurological symptoms generally remained unchanged after surgery, 47% of affected patients reported a postoperative improvement of their pain syndrome. After 3 months, 51% considered their postoperative status improved and 41% considered it unchanged. In the long-term, favorable results were obtained for Groups A and C with rates for neurological deterioration of 6% and 14% after 5 years, respectively. In Group B, this rate was considerably higher at 39%, because arachnolysis and untethering to preserve residual cord function could not be fully achieved in all patients. Cordectomy led to neurological improvement and syrinx collapse in all 4 patients.ConclusionsThe technique of decompression with arachnolysis, untethering, and duraplasty at the level of the underlying trauma provides good long-term results for patients with progressive neurological symptoms following ASIA A, B and E injuries. Treatment of patients with posttraumatic syringomyelia after spinal cord injuries with preserved motor functions (ASIA C and D) remains a major challenge. Future studies will have to establish whether thecoperitoneal shunts would be a superior alternative for this subgroup.

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Section: Clinical Presentationmentioning

confidence: 99%

“…For patients with a complete cord lesion, cordectomy is a very effective form of treatment for syringomyelia 17,22,31,41,57,74 (Fig. 3).…”

Section: Surgical Managementmentioning

confidence: 99%

Treatment of posttraumatic syringomyelia

Klekamp¹

2012

SPI

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“…All cohorts/samples were independent, and we could not identify any overlap of included individuals. Overall, the sample sizes of the clinical studies detected by literature search ranged from case series of three up to studies including 600 individuals [ 2 , 4 , 5 , 9 , 11 , 13 , 14 , 16 , 18 , 23 – 40 , 42 – 53 , 55 , 56 , 59 , 60 , 62 ]. Observational designs were applied in all studies.…”

Section: Resultsmentioning

confidence: 99%

Treatment of posttraumatic syringomyelia: evidence from a systematic review

Kleindienst

Laut

Roeckelein³

et al. 2020

Acta Neurochir

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Background Following spinal cord injury (SCI), the routine use of magnetic resonance imaging (MRI) resulted in an incremental diagnosis of posttraumatic syringomyelia (PTS). However, facing four decades of preferred surgical treatment of PTS, no clear consensus on the recommended treatment exists. We review the literature on PTS regarding therapeutic strategies, outcomes, and complications. Methods We performed a systematic bibliographic search on (“spinal cord injuries” [Mesh] AND “syringomyelia” [Mesh]). English language literature published between 1980 and 2020 was gathered, and case reports and articles examining syrinx due to other causes were excluded. The type of study, interval injury to symptoms, severity and level of injury, therapeutic procedure, duration of follow-up, complications, and outcome were recorded. Results Forty-three observational studies including 1803 individuals met the eligibility criteria. The time interval from SCI to the diagnosis of PTS varied between 42 and 264 months. Eighty-nine percent of patients were treated surgically (n = 1605) with a complication rate of 26%. Symptoms improved in 43% of patients postoperatively and in 2% treated conservatively. Stable disease was documented in 50% of patients postoperatively and in 88% treated conservatively. The percentage of deterioration was similar (surgery 16%, 0.8% dead; conservative 10%). Detailed analysis of surgical outcome with regard to symptoms revealed that pain, motor, and sensory function could be improved in 43 to 55% of patients while motor function deteriorated in around 25%. The preferred methods of surgery were arachnoid lysis (48%) and syrinx drainage (31%). Conclusion Even diagnosing PTS early in its evolution with MRI, to date, no satisfactory standard treatment exists, and the present literature review shows similar outcomes, regardless of the treatment modality. Therefore, PTS remains a neurosurgical challenge. Additional research is required using appropriate study designs for improving treatment options.

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“…4 Many papers have reported good outcomes after spinal cord transection for PTS. 2,[5][6][7][8] In an excellent revision, 9 Konar et al recently analyzed the surgical outcomes of cordectomies for different indications: PTS, subacute posttraumatic ascending myelopathy (SPAM), central pain of spinal cord origin, spasticity, spinal cord tumors and myelomenyngocele. They found 60 cases of cordectomy for PTS: results showed 78.3% excellent improvement, 13.4% stabilization and 8.3% deterioration.…”

Section: Discussionmentioning

confidence: 99%

“…Cordectomies have been performed for years, but gained popularity in the last decade, especially in patients with complete spinal cord damage. 2 We present a modification of this technique, which may achieve similar good results in terms of syringomyelia resolution, sparing the negative implications of complete cord transection.…”

Section: Introductionmentioning

confidence: 99%

Myelopexy: A novel technique in posttraumatic syringomyelia

Pellejero

Martínez

López

et al. 2022

Neurocirugía (English Edition)

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Posttraumatic syringomyelia (PTS) is a well-reported phenomenon that usually takes place in the long-term course of patients following spinal cord injury. Different surgical procedures have been described: spinal cordectomy is usually a last option technique, but might be an excellent choice in patients with severe spinal cord injuries.We present a young patient with complete spinal cord injury after spine trauma, who developed posttraumatic syringomyelia with progressive motor deterioration twelve years after fixation. We performed a novel surgical technique (myelopexy) with excellent resolution of syringomyelia, sparing the negative implications of complete cord transection.

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Impact of cordectomy as a treatment option for posttraumatic and non-posttraumatic syringomyelia with tethered cord syndrome and myelopathy

Abstract: Cordectomy can be a useful instrument to preserve functions of the upper extremities and to improve spasticity and pain in patients with severe myelopathy and tethered cord, syringomyelia, or arachnopathy of various etiologies.

Cited by 18 publications

References 13 publications

Treatment of posttraumatic syringomyelia

Treatment of posttraumatic syringomyelia

Treatment of posttraumatic syringomyelia: evidence from a systematic review

Myelopexy: A novel technique in posttraumatic syringomyelia

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