Abstract
Study designRetrospective population-based cohort study.ObjectiveTo investigate the long-term outcome following surgery for posttraumatic spinal cord tethering (PSCT).SettingPublicly funded tertiary care center.MethodsPatients surgically treated for PSCT between 2005–2020 were identified and included. No patients were excluded or lost to follow-up. Medical records and imaging data were retrospectively reviewed.ResultsSeventeen patients were included. Median age was 52 (23–69) years and 7 (41%) were female. PSCT was diagnosed at a median of 5.0 (0.6–27) years after the initial trauma. Motor deficit was the most common neurological manifestation (71%), followed by sensory deficit (53%), spasticity (53%), pain (41%) and gait disturbance (24%). Median follow-up time was 5.1 (0.7–13) years. Fifteen patients (88%) showed satisfactory results following untethering, defined as improvement or halted progression of one or more of the presenting symptoms. Treatment goals were met for motor symptoms in 92%, sensory loss in 100%, spasticity in 100%, gait disturbance in 100% and pain in 86%. Statistically, a significant improvement in motor deficit (p = 0.031) and syrinx decrease (p = 0.004) was also seen. A postoperative complication occurred in four patients: three cases of cerebrospinal fluid leakage and one postoperative hematoma. Two patients showed a negative surgical outcome: 1 with increased neck pain and 1 with left arm weakness following the postoperative hematoma.ConclusionSurgical treatment of PSCT results in improved neurological function or halted neurological deterioration in the vast majority of patients.
Highlights
Spinal trauma may lead to spinal cord injury and different degrees of associated neurological deficits at and below the level of the lesion [1]
Posttraumatic spinal cord tethering (PSCT) (Figs. 1, 2) including excessive arachnoid scar formation is recognized as an underlying factor for cyst formation or posttraumatic syringomyelia (PS) [4,5,6,7,8]
We present our institutional experience from surgical treatment of PSCT, with special emphasis on the management and results in relation to concomitant PS
Summary
Spinal trauma may lead to spinal cord injury and different degrees of associated neurological deficits at and below the level of the lesion [1]. Delayed syrinx or cyst formation in combination with a progressive neurological decline has been generally recognized and accepted as a result of traumatic spinal cord injury [2, 3]. Due to the fact that not all clinical aggravations in chronic spinal cord injuries are accompanied by PS, the term progressive posttraumatic myelopathy (PPM) was introduced to emphasize the fact that neurological decline as a result of tethering may occur with or without a co-existing PS formation [3, 4]. As a result of PPM, spinal cord injury patients may develop a progressive ascending neurological deterioration within a time frame that ranges from a few months up to several decades after the initial trauma [1, 3, 6, 7, 9,10,11,12]. The symptomatology of PPM consists of impaired motor and sensory function, abnormality of temperature sensation, worsening of spasticity, pain, autonomic impairment, hyperhidrosis, Horner’s syndrome, and bowel and bladder dysfunction [1, 3, 5,6,7,8,9,10,11,12,13,14,15]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
