Surgical Treatment of Posttraumatic Cystic and Tethered Spinal Cords

Posttraumatic syringomyelia as a cause of progressive neurologic deterioration has been well described. More recently, the noncystic posttraumatic tethered cord has been associated with identical progressive neurologic deterioration. A retrospective analysis of patients treated surgically with spina...

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Bibliographic Details
Published in:	The journal of spinal cord medicine Vol. 22; no. 3; pp. 173 - 181
Main Authors:	Falci, P. Scott, Lammertse, P. Daniel, Best, Lavar, Starnes, A. Charlotte, Prenger, Erin, Stavros, Anthony, Mellick, Dave
Format:	Journal Article
Language:	English
Published:	England Taylor & Francis 01-01-1999
Subjects:	Adolescent Adult Aged Child cyst Female Follow-Up Studies Humans Magnetic Resonance Imaging Male Middle Aged Neural Tube Defects - diagnosis Neural Tube Defects - surgery Neurologic Examination Postoperative Complications - diagnosis posttraumatic Spinal Cord - pathology Spinal Cord - surgery Spinal Cord Injuries - diagnosis Spinal Cord Injuries - surgery Syringomyelia Syringomyelia - diagnosis Syringomyelia - surgery tethered cord tethering Ultrasonography
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Summary:	Posttraumatic syringomyelia as a cause of progressive neurologic deterioration has been well described. More recently, the noncystic posttraumatic tethered cord has been associated with identical progressive neurologic deterioration. A retrospective analysis of patients treated surgically with spinal cord untethering and/or cyst shunting to arrest a progressive myelopathy from a posttraumatic tethered and/or cystic cord was performed. Emphasis was on outcome using the American Spinal Injury Association (ASIA) sensory and motor scoring systems. During an 18-month period from May 1993 to December 1994, 70 patients with spinal cord injury were operated upon for tethered and/or cystic spinal cords because of a progressive myelopathy and deteriorating ASIA sensory/motor scores. Fifty-nine patients had follow-up data 1 year postoperatively. At the 1 year follow-up, there was small improvement in light touch sensory scores (0.67 points), pinprick scores (1.3 points), and motor scores (0.41 points) demonstrating that the progression of the myelopathic process was arrested. Thirty-four of these 59 patients had no previous surgery to their spinal cords. At 1 year follow-up, light touch scores improved on average 2.38 points, pinprick scores 3.88 points (p < 0.05), and motor scores 1.47 points, suggesting better outcome with first-time surgery. Of this latter group, 64.3% regained a lost function, 62.5% saw improvement in spasticity, 55.6% had substantial improvement in neurogenic pain, and 95.8% felt that surgery prevented further neurologic deterioration.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1079-0268 2045-7723
DOI:	10.1080/10790268.1999.11719567