Treatment of posttraumatic syringomyelia: evidence from a systematic review

Abstract

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.

Multiple therapeutic effects of human neural stem cells derived from induced pluripotent stem cells in a rat model of post-traumatic syringomyelia

“…However, a recent systematic review concluded that "no satisfactory standard treatment exists". 26 We hypothesize that transplantation of neural stem and progenitor cells in conjunction with surgical treatment results in higher efficacy. In our previous study, we demonstrated that human NPCs derived either from prenatal tissue or iPSCs (i.e., NESCs) effectively reversed intraspinal cyst expansion in a rat model of PTS, 15 but if these transplanted cells can also achieve tissue repair has not been studied.…”

Coexistence of Systemic Lupus Erythematosus and Syringomyelia: A Case From a Rural Center in Nigeria

“…However, several hypothetical theories have been postulated to explain the development of syringomyelia [ 3 , 11 ]. Syringomyelia has been associated with non-infectious inflammatory lesions [ 12 ]. Hypotheses on the pathophysiology of non-infectious inflammation-associated syringomyelia include coincidence, necrosis, or ex-vacuum central canal dilation due to myelin/axonal damage [ 4 ].…”

“…The coexistence of SLE and syringomyelia in this patient may be coincidental, as syringomyelia is becoming more prevalent and can be discovered incidentally as a result of the increased use of MRI in the routine evaluation of back and neck pain [ 12 ]. It is possible that the autoimmune inflammation associated with SLE contributes to the formation of syrinxes.…”

Long-term outcome following surgical treatment of posttraumatic tethered cord syndrome: a retrospective population-based cohort study

“…Uncertainty exists regarding the management of PS and a recent meta-analysis identified that the past four decades have failed to produce a consensus regarding its treatment [16]. Similarly, a consensus panel agreed that the evidence was poor but suggested detethering with dural expansion as a first treatment strategy for PSCT and PS [9].…”