Posttraumatic Spinal Cord Tethering and Syringomyelia: A Retrospective Investigation of Patients With Progressive Disease and Surgical Revisions.

IF 1.7 Q2 SURGERY

International Journal of Spine Surgery Pub Date : 2025-01-08 DOI:10.14444/8716

Crescenzo Capone, Denis Bratelj, Susanne Stalder, Phillip Jaszczuk, Marcel Rudnick, Rajeev K Verma, Tobias Pötzel, Michael Fiechter

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引用次数: 0

Abstract

Background: Spinal cord tethering and syringomyelia after trauma are well-known pathologies in patients suffering from spinal cord injury (SCI). In symptomatic cases, various surgical options are available, but untethering and expansion duraplasty is the currently preferred treatment strategy. However, patient outcomes are usually limited by rather high rates of surgical revisions. The aim of the present study was to identify risk factors in SCI patients who underwent multiple surgeries for symptomatic spinal cord tethering and syringomyelia.

Methods: We retrospectively investigated 25 patients who received at least 2 untethering surgeries of the spinal cord. All patients were treated by untethering and expansion duraplasty and/or clinically followed between 2012 and 2022 at the Swiss Paraplegic Center.

Results: A higher location of SCI correlates with a more rapid development of symptomatic spinal cord retethering in need of surgical revision (r = 0.406 and P = 0.044). Interestingly, the extent of spinal cord tethering is lower in those patients who underwent an early surgical intervention (r = 0.462 and P = 0.030), which points toward an increased vulnerability of the spinal cord at higher levels. Ninety-two percent of the patients displayed a potentially chronic inflammatory condition with a mean level of C-reactive protein of 28.4 ± 4.1 mg/L, while the white blood cell count was identified as an independent predictor for surgical interventions in symptomatic cases.

Conclusions: Revision surgery in posttraumatic spinal cord tethering and syringomyelia patients is associated with the location of SCI and the extent of spinal cord tethering. It appears that chronic inflammatory conditions might play an important role in promoting spinal cord retethering and thus warrant further investigation.

Clinical relevance: SCI patients with chronic inflammatory conditions and SCI at upper levels should be clinically monitored more carefully as they appear to be more susceptible to progressive forms of posttraumatic spinal cord tethering and syringomyelia.

Level of evidence: 3:

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创伤后脊髓栓系和脊髓空洞：疾病进展和手术修复患者的回顾性调查。

背景：创伤后脊髓栓系和脊髓空洞是脊髓损伤（SCI）患者常见的病理。在有症状的病例中，有多种手术选择，但解开和扩大硬膜成形术是目前首选的治疗策略。然而，患者的预后通常受到相当高的手术修复率的限制。本研究的目的是确定因症状性脊髓栓系和脊髓空洞而接受多次手术的脊髓损伤患者的危险因素。方法：我们回顾性调查了25例接受过至少2次脊髓解栓手术的患者。所有患者在2012年至2022年期间在瑞士截瘫中心接受解栓和扩张硬脑膜成形术和/或临床随访。结果：脊髓损伤位置越高，需要手术翻修的症状性脊髓再栓发展越快（r = 0.406, P = 0.044）。有趣的是，在那些接受早期手术干预的患者中，脊髓栓系的程度较低（r = 0.462, P = 0.030），这表明脊髓的脆弱性在更高的水平上增加。92%的患者表现出潜在的慢性炎症，平均c反应蛋白水平为28.4±4.1 mg/L，而白细胞计数被确定为有症状病例手术干预的独立预测因子。结论：创伤后脊髓栓系和脊髓空洞患者的翻修手术与脊髓损伤的位置和脊髓栓系的程度有关。看来慢性炎症条件可能在促进脊髓再系缚中起重要作用，因此值得进一步研究。临床相关性：慢性炎症性脊髓损伤患者和脊髓损伤水平较高的脊髓损伤患者应在临床更仔细地监测，因为他们似乎更容易出现创伤后脊髓栓系和脊髓空洞的进行性形式。证据等级：3；

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来源期刊

International Journal of Spine Surgery Medicine-Surgery

CiteScore

3.10

自引率

0.00%

发文量

162

期刊介绍： The International Journal of Spine Surgery is the official scientific journal of ISASS, the International Intradiscal Therapy Society, the Pittsburgh Spine Summit, and the Büttner-Janz Spinefoundation, and is an official partner of the Southern Neurosurgical Society. The goal of the International Journal of Spine Surgery is to promote and disseminate online the most up-to-date scientific and clinical research into innovations in motion preservation and new spinal surgery technology, including basic science, biologics, and tissue engineering. The Journal is dedicated to educating spine surgeons worldwide by reporting on the scientific basis, indications, surgical techniques, complications, outcomes, and follow-up data for promising spinal procedures.