Perilesional myeloradiculopathy with tethered cord in post-traumatic spinal cord injury

Abstract

Study design: A retrospective series of cases. Objective: To identify, among post-traumatic myelopathies, a specific entity in which clinical and radiological features are not extensive but are strictly limited to the perilesional zone. Setting: The data set of the Regional Spinal Cord Injury Department of Nantes, France. Methods: A systematic analysis of all traumatic spinal cord injury (SCI) patients who presented with a neurological aggravation delayed from initial injury, without syringomyelia or extensive myelomalacia. Results: Twelve patients presenting with this type of complication were identified (that is, four tetraplegics and eight paraplegics). The neurological worsening consisted in weakness of the muscles close to the motor level in five patients, and in isolated at-level neuropathic pain in seven patients. A tethered cord was evidenced by the magnetic resonance imaging (MRI) results in all of the patients. Roots were involved by the tethering on the MRI results in eight cases. Surgery, with untethering and expansile duraplasty, was performed in all cases. Surgery allowed motor recovery in patients who presented with a motor loss (motor score gain range ¼ 1-7 points; median ¼ 3) and decreased pain in all pain patients (decrease on the 10-point numerical rating scale: range ¼ 1-6 points; median ¼ 4). Conclusions: In traumatic SCI patients, a tethered cord could be responsible for clinical and radiological changes, which are strictly localised to the perilesional area. The term perilesional myeloradiculopathy is proposed for this complication, which requires cord release surgery.

Characterization of spinal subarachnoid bleeding associated to graded traumatic spinal cord injury in the rat

“…5 Arachnoiditis, in turn, may lead to syringomyelia by alterations in dynamics of CSF flow 17 and spinal neuropathic pain due to nerve root entrapment. 18 …”

Spatial and Temporal Morphological Changes in the Subarachnoid Space after Graded Spinal Cord Contusion in the Rat

“…Taking into account the pathological changes observed at the site of injury, mainly in severe injuries, including cord tethering and irregular surface of the cord by pial fibrosis and nerve root traps, it is possible that CSF flow dynamics are altered as suggested by others. 24,25 These pathological changes, defined as post-traumatic arachnoiditis, have been associated with late neurological worsening related 26,27 or not 28 to syringomyelia. Arachnoiditis results from the evolution of acute meningeal inflammation to late scarring.…”