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

Abstract

A retrospective series of cases. 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. The data set of the Regional Spinal Cord Injury Department of Nantes, France. 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. 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=1-7 points; median=3) and decreased pain in all pain patients (decrease on the 10-point numerical rating scale: range=1-6 points; median=4). 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.