Spinal cord tethering and syringomyelia after trauma: impact of age and surgical outcome

Scientific Reports, 2023 · DOI: https://doi.org/10.1038/s41598-023-38565-0 · Published: July 11, 2023

Spinal Cord Injury Surgery Spinal Disorders

Simple Explanation

Posttraumatic spinal cord tethering and syringomyelia can lead to progressive neurological loss after spinal cord injury (SCI). The study aimed to investigate demographic variability and treatment efficacy. The study retrospectively investigated 67 patients who were surgically treated for symptomatic spinal cord tethering and syringomyelia. The patients underwent spinal cord detethering with expansion duraplasty in combination with or without cyst/syrinx shunting. The study found that active screening for symptomatic spinal cord tethering and syringomyelia, particularly in younger patients with severe spinal trauma, is crucial, as surgical untethering with/without shunting can achieve favorable clinical outcomes.

Study Duration

10 Years

Participants

67 patients (56 men, 11 women)

Evidence Level

Retrospective observational monocenter study

Key Findings

1
Age and severity of trauma to the spinal cord were identified as independent predictors for the rate of development of symptomatic spinal cord tethering and syringomyelia.
2
Following untethering surgery, 65.9% of patients demonstrated an improvement of neurological loss, and 50.0% displayed amelioration of spasticity and/or neuropathic pain.
3
Younger patients with a higher level of SCI are susceptible for a more rapid development of clinically relevant spinal cord tethering and syringomyelia as compared to older patients.

Research Summary

This retrospective study investigated 67 patients with posttraumatic spinal cord tethering and syringomyelia who underwent surgical treatment. The study aimed to identify demographic predictors and assess the efficacy of surgical untethering with or without shunting. The results indicated that younger age and severe spinal trauma are independent risk factors for the development of symptomatic spinal cord tethering and syringomyelia. Surgical untethering demonstrated significant improvement in neurological loss and amelioration of spasticity and neuropathic pain in a majority of patients. The study concludes that active screening for symptomatic spinal cord tethering and syringomyelia is crucial, particularly in younger patients with severe spinal trauma, as surgical intervention can lead to favorable clinical outcomes and personalized patient care.

Practical Implications

Personalized Treatment Strategies

Clinicians can tailor treatment strategies based on patient age and trauma severity, focusing on early detection and intervention in younger patients with severe spinal trauma.

Early Screening for High-Risk Patients

Active screening for symptomatic spinal cord tethering and syringomyelia, especially in younger patients with severe spinal trauma, is crucial for timely surgical intervention.

Surgical Intervention Benefits

Surgical untethering with expansion duraplasty, with or without shunting, can effectively improve neurological outcomes and alleviate spasticity and neuropathic pain in SCI patients with symptomatic spinal cord tethering and syringomyelia.

Study Limitations

1
Retrospective study design at a single treatment center, introducing potential biases.
2
Lack of standardized quantitative measurements or scores for pre- and postoperative symptomatology and function.
3
Heterogeneity of products used for expansion duraplasty, which could impact revision rates.

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