Neurosurgical untethering with or without syrinx drainage results in high patient satisfaction and favorable clinical outcome in post-traumatic myelopathy patients

Holmström, Ulrika; Tsitsopoulos, Parmenion P.; Flygt, Hjalmar; Holtz, Anders; Marklund, Niklas

doi:10.1038/s41393-018-0094-y

Cited by 9 publications

(25 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Studies on a larger patient population may provide insight into the mechanisms causing progressive neurological deterioration in these patients. Following traumatic SCI, the clinical entity of delayed neurological worsening up to many years post-injury is well established [14,24,27,32,34]. The condition is named post-traumatic syringomyelia or preferably progressive posttraumatic myelopathy (PPM).…”

Section: Discussionmentioning

confidence: 99%

“…To date, the pathophysiology of PPM has not been fully clarified [24]. Hence, we assessed 3 biomarkers, namely GFAP, p-NFH, and UCH-L1, each linked to different cell origin and pathophysiological mechanisms that could help us appreciate the etiology and underlying processes predisposing to spinal cord tethering.…”

Section: Discussionmentioning

confidence: 99%

“…2a, b) to restore CSF flow. When an intramedullary cyst persisted after dural opening, as controlled by intraoperative ultrasound, a syringosubarachnoidal shunt was placed [24]. In all patients, the dura was closed and expanded using a dural graft (Durepair®, Medtronic, Memphis, TN) that was sutured using resorbable sutures.…”

Section: Surgical Proceduresmentioning

confidence: 99%

“…Glial scar formation, resulting in spinal cord tethering, may become clinically evident many years following spinal cord injury (SCI), irrespective of the initial injury mechanism or severity [11,12,14,24]. When the spinal cord is tethered to the surrounding dura, impaired cord pulsations, reduced flow of the cerebrospinal fluid, and/or spinal cord traction can lead to neurological dysfunction and/or spinal cord cyst formation (syringomyelia) [18,33,52].…”

Section: Introductionmentioning

confidence: 99%

“…When the spinal cord is tethered to the surrounding dura, impaired cord pulsations, reduced flow of the cerebrospinal fluid, and/or spinal cord traction can lead to neurological dysfunction and/or spinal cord cyst formation (syringomyelia) [18,33,52]. Most symptomatic spinal cord tethering occurs secondary to traumatic SCI where up to 5% of patients develop progressive neurological deterioration after a few months up to many years following the initial injury [11,14,24,43]. This clinical entity is named post-traumatic myelopathy.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Cerebrospinal fluid levels of GFAP and pNF-H are elevated in patients with chronic spinal cord injury and neurological deterioration

et al. 2020

Self Cite

View full text Add to dashboard Cite

Background Years after a traumatic spinal cord injury (SCI), a subset of patients may develop progressive clinical deterioration due to intradural scar formation and spinal cord tethering, with or without an associated syringomyelia. Meningitis, intradural hemorrhages, or intradural tumor surgery may also trigger glial scar formation and spinal cord tethering, leading to neurological worsening. Surgery is the treatment of choice in these chronic SCI patients. Objective We hypothesized that cerebrospinal fluid (CSF) and plasma biomarkers could track ongoing neuronal loss and scar formation in patients with spinal cord tethering and are associated with clinical symptoms. Methods We prospectively enrolled 12 patients with spinal cord tethering and measured glial fibrillary acidic protein (GFAP), ubiquitin C-terminal hydrolase L1 (UCH-L1), and phosphorylated Neurofilament-heavy (pNF-H) in CSF and blood. Seven patients with benign lumbar intradural tumors and 7 patients with cervical radiculopathy without spinal cord involvement served as controls. Results All evaluated biomarker levels were markedly higher in CSF than in plasma, without any correlation between the two compartments. When compared with radiculopathy controls, CSF GFAP and pNF-H levels were higher in patients with spinal cord tethering (p ≤ 0.05). In contrast, CSF UCH-L1 levels were not altered in chronic SCI patients when compared with either control groups. Conclusions The present findings suggest that in patients with spinal cord tethering, CSF GFAP and pNF-H levels might reflect ongoing scar formation and neuronal injury potentially responsible for progressive neurological deterioration. Keywords Spinal cord injury. Biomarkers. Syringomyelia. Cerebrospinal fluid. Tethering of the spinal cord (TSC). Glial fibrillary acidic protein (GFAP). Ubiquitin C-terminal hydrolase L1 (UCH-L1). Neurofilament. Post-traumatic myelopathy This article is part of the Topical Collection on Spine-Other

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Surgical Proceduresmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Cerebrospinal fluid levels of GFAP and pNF-H are elevated in patients with chronic spinal cord injury and neurological deterioration

et al. 2020

Self Cite

View full text Add to dashboard Cite

show abstract

Treatment of posttraumatic syringomyelia: evidence from a systematic review

Kleindienst

Laut

Roeckelein³

et al. 2020

Acta Neurochir

View full text Add to dashboard Cite

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.

show abstract

Aging with spinal cord injury: A narrative review of consequences and challenges

Guı́zar-Sahagún¹,

Grijalva²,

Franco-Bourland³

et al. 2023

Ageing Research Reviews

View full text Add to dashboard Cite

Neurosurgical untethering with or without syrinx drainage results in high patient satisfaction and favorable clinical outcome in post-traumatic myelopathy patients

Abstract: Neurosurgical untethering and/or cyst drainage in chronic SCI patients and PPM resulted in a high degree of patient satisfaction, particularly in cervical SCI patients with minimal complications.

Cited by 9 publications

References 31 publications

Cerebrospinal fluid levels of GFAP and pNF-H are elevated in patients with chronic spinal cord injury and neurological deterioration

Cerebrospinal fluid levels of GFAP and pNF-H are elevated in patients with chronic spinal cord injury and neurological deterioration

Treatment of posttraumatic syringomyelia: evidence from a systematic review

Aging with spinal cord injury: A narrative review of consequences and challenges

Contact Info

Product

Resources

About