Post-traumatic syringomyelia and post-traumatic spinal canal stenosis: A direct relationship: Review of 75 patients with a spinal cord injury

Abstract

This study aims to demonstrate predictive factors for post traumatic syringomyelia (PTS), and in particular to correlate the role of insu ciency of reduction of a spinal fracture with the occurrence of syringomyelia. One hundred and twenty-eight spinal cord injured patients (SCI) were studied during the years 1992 and 1993. Among them, 75 underwent a complete and reliable evaluation including: review of the initial vertebral lesion, and of the surgery report, and a radiological study of the lesion site with standard X-rays, a CT scan, and an MRI. The CT Scan included slices in sagittal reconstructions and in the axial plane at the site of injury with the calculation of a percentage of canal stenosis in the two planes of the space. An MRI was carried out with T1 and T2 weighted images, including sagittal entire cord images in addition to sagittal and axial slices centred on the site of injury. A syrinx was diagnosed in 28% of the patients. The occurrence of a syrinx is signi®cantly correlated with spinal canal stenosis in the sagittal plane (DD) with a P50.001 and in the axial plane (DS) (P50.05). This present study demonstrates the major role of the insu ciency of reduction of the vertebral lesion in the genesis of a syrinx. The quality of the initial treatment of the vertebral injury is the ®rst step in the prevention of a syrinx. The treatment of a syrinx, besides techniques of drainage, must also take into account the spinal realignment.

Factors associated with early onset post-traumatic syringomyelia

“…However, other studies suggest that syringomyelia development may be associated with the injury site. Sgouros and Williams 17 found that 78% of syringomyelia patients had a thoracolumbar spinal injury, whereas El Masry et al 5 and PerrouinVerbe et al 9 concluded that cavities form more commonly in thoracic compared with cervical spinal cord injury patients. In contrast, Rossier et al, 14 Lyons et al, 18 and Vannemreddy et al 6 found that syringomyelia was more commonly associated with cervical spinal cord injury.…”

“…Factors examined include: age at onset, gender, cause of injury, site of injury, severity of injury, type of vertebral fracture, treatment method and the degree of encroachment into the vertebral canal. 6,9 Complete spinal cord injury and arachnoiditis have been associated with an increased incidence of post-traumatic syringomyelia, and increasing age, damage at the cervical and thoracic levels, dislocated spinal fracture and the use of spinal instrumentation without decompression have all been identified as risk factors for the early development of posttraumatic syringomyelia. 6 To date, however, none of those factors have been established as being definitively causative.…”

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

“…At T 1 , spinal canal stenosis was measured using the method previously described by Perrouin-Verbe et al 2 The most recent MRI was examined to identify the post-traumatic spinal cord lesions using the criteria defined by Wang et al 8 At T 2 , the MRI that was performed because of the neurological worsening was assessed using the abovementioned criteria.…”

“…[1][2][3][4][5][6][7] Cord tethering, defined as attachment of the spinal cord to the wall of the bony spinal canal, 8 is known to be a major factor in the occurrence of such a complication. [3][4][5]9,10 The long-term SCI patient follow-up highlights that PTM is a frequent complication among these patients.…”

“…[3][4][5]9,10 The long-term SCI patient follow-up highlights that PTM is a frequent complication among these patients. 2 In addition to urinary, respiratory, vascular or cutaneous complications, PTM should be screened for and treated. PTMs, which can be either cystic (posttraumatic syringomyelia) or non-cystic (post-traumatic progressive myelomalacic myelopathy), are referred to as progressive pathologies.…”