Syringomyelia as a sequel to traumatic paraplegia

Williams, Bernard; Terry, Arthur F.; Jones, Helen; McSweeney, T

doi:10.1038/sc.1981.18

Cited by 77 publications

(42 citation statements)

References 26 publications

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“…It seems from the behaviour of the intrathecal contrast that the cord forming the walls of a syrinx is largely permeable to small molecules in cases of syringomyelia. Once there is a quantity of fluid within the cord of course, the method of advance is probably related to sloshing of fluid (Williams et al , 1981). The surging of the fluid is due to the compression of the dura by rapid distension of the epidural veins and the energy involved is great.…”

Section: Pathogenesismentioning

confidence: 99%

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Post-traumatic syringomyelia, an update

Williams

1990

Spinal Cord

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SummaryPost-traumatic and post-arachnoiditic syringomyelia is described in 31 patients from the Midland Centre for Neurosurgery and Neurology (MCNN). It is suggested that the mechanisms may be similar in the two groups and that treatment is best directed to disabling the likely filling mechanisms by opening up the cerebrospinal fluid (CSF) pathways and deliberately leaving the dura open to create an artificial meningocele. It is suggested that drainage on its own is inappropriate but that when drainage of the syrinx is chosen as an ancillary technique then syringopleural drainage may be the procedure of choice. Key words: Spinal cord injuries; Syringomyelia; Arachnoiditis; Post-traumatic cystic myelopathy.Since the presentation of 10 cases of post-traumatic syringomyelia to the IMSOP (Williams et al., 1981) further cases have been seen. The majority of these have been cases with complete or partial paraplegia. Because of the important similarities, the blockage of the CSF pathways around the cord, the upward extension of the syrinx cavities, particularly in association with straining and the tendency to progress, sometimes many years after the causative lesions, it seems probable that the mechanism of the syringomyelia is often similar in both the post-traumatic and the post-inflammatory types of case. The main difference between them seems to be that in some of the post-traumatic cases the condition becomes evident early, only a few months after the initial cord involvement. This may be a manifestation of a supposed haematoma at the site of injury. This possibility is largely unexplored at present and it is therefore not possible to separate the cases retrospectively. Thirty one cases are presented with 7 of them being non-traumatic and the principles of treatment discussed for both types together. Initial results of treatment have been disappointing and have lead to emphasis in surgical management being placed on prevention of the filling mechanisms and the replacement of syringo subarachnoid shunting by more forceful methods of drainage using shunting from syrinx to extrathecal sites, the pleural cavity being chosen in the more recent cases

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Section: Pathogenesismentioning

confidence: 99%

“…Since the presentation of 10 cases of post-traumatic syringomyelia to the IMSOP (Williams et al, 1981) further cases have been seen. The majority of these have been cases with complete or partial paraplegia.…”

mentioning

confidence: 99%

Post-traumatic syringomyelia, an update

Williams

1990

Spinal Cord

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“…32,33 The mechanism of extension of the cavity seems to be mainly related to pressure changes in the venous system, by the action of intraspinal veins on cerebral spinal fluid pressure. 43,44 The fixation of the spinal cord by adhesions and arachnoiditis at the site of the lesion also appears to play a role. 4,19 The first symptom in most cases is pain, which is increased by straining, coughing or sneezing/ 27, 41 followed by sensory deficit, motor loss and increase of spasticity.29 Autonomous symptoms such as abnormal sweating or hypertension are less frequent,29 but can also be the first symptom.…”

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confidence: 99%

Post-spinal cord injury syringomyelia

Umbach

Heilporn

1991

Spinal Cord

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The incidence of post-traumatic syringomyelia ranges between 0·3 and 3·2%, dependent on the authors, with a mean of about 1·3%. 2,7, 2S, 27, 29, 33, 41, 42 The interval between spinal trauma and the appearance of neurological symp The first symptom in most cases is pain, which is increased by straining, coughing or sneezing/ 27, 41 followed by sensory deficit, motor loss and increase of spasticity.29 Autonomous symptoms such as abnormal sweating or hypertension are less frequent,29 but can also be the first symptom.37 The earliest clinical sign is loss of reflexes. 7, 42Diagnostic techniques have undergone an important evolution in recent years.Oil and gas myelography being replaced by metrizamide myelography associated with CT scan imaging. The recently developed MR imaging has now become the technique of choice. 11, 3 6 Intra-operative sonography is used to detect septations

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“…Williams considered the presence of scars of the dura and arachnoid at the site of injury to be a critical factor in the genesis of a syrinx. 4 Edgar and Quail emphasised the role of the tethered cord in both forms of PTMs. 3 Many works have confirmed the causal link between arachnoiditis and syrinx 15,16 or myelomalacic myelopathies.…”

Section: Discussionmentioning

confidence: 99%

“…[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. 2 In addition to urinary, respiratory, vascular or cutaneous complications, PTM should be screened for and treated.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2012

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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.

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Syringomyelia as a sequel to traumatic paraplegia

Abstract: Abstract. Ten cases of post-traumatic paraplegia are described in whom syringomyelia symptoms have supervened. Five patients have been operated upon after investigation. Operative results have been encouraging. A discussion of likely pathogenetic mechanisms is presented.

Cited by 77 publications

References 26 publications

Post-traumatic syringomyelia, an update

Post-traumatic syringomyelia, an update

Post-spinal cord injury syringomyelia

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

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