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Decompressive Surgery in a Patient with Posttraumatic Syringomyelia

  • Byun, Min-Seok (Department of Neurosurgery, Sanggye Paik Hospital, Inje University College of Medicine) ;
  • Shin, Jun-Jae (Department of Neurosurgery, Sanggye Paik Hospital, Inje University College of Medicine) ;
  • Hwang, Yong-Soon (Department of Neurosurgery, Sanggye Paik Hospital, Inje University College of Medicine) ;
  • Park, Sang-Keun (Department of Neurosurgery, Sanggye Paik Hospital, Inje University College of Medicine)
  • Received : 2009.05.27
  • Accepted : 2010.01.12
  • Published : 2010.03.28

Abstract

Posttraumatic syringomyelia may result from a variety of inherent conditions and traumatic events, or from some combination of these. Many hypotheses have arisen to explain this complex disorder, but no consensus has emerged. A 28-year-old man presented with progressive lower extremity weakness, spasticity, and decreased sensation below the T4 dermatome five years after an initial trauma. Magnetic resonance imaging (MRI) revealed a large, multi-septate syrinx cavity extending from C5 to L1, with a retropulsed bony fragment of L2. We performed an L2 corpectomy, L1-L3 interbody fusion using a mesh cage and screw fixation, and a wide decompression and release of the ventral portion of the spinal cord with an operating microscope. The patient showed complete resolution of his neurological symptoms, including the bilateral leg weakness and dysesthesia. Postoperative MRI confirmed the collapse of the syrinx and restoration of subarachnoid cerebrospinal fluid (CSF) flow. These findings indicate a good correlation between syrinx collapse and symptomatic improvement. This case showed that syringomyelia may develop through obstruction of the subarachnoid CSF space by a bony fracture and kyphotic deformity. Ventral decompression of the obstructed subarachnoid space, with restoration of spinal alignment, effectively treated the spinal canal encroachment and post-traumatic syringomyelia.

Keywords

References

  1. Barnett HJ, Botterell EH, Jousse AT, Wynn-Jones M : Progressive myelopathy as a sequel to traumatic paraplegia. Brain 89 : 159-174, 1966 https://doi.org/10.1093/brain/89.1.159
  2. Bastian HC : On a case of concussion lesion with extensive secondary degeneration of the spinal cord. Proc Royal Med Chirurg Soc Lond 50 : 499, 1867
  3. Batzdorf U, Klekamp J, Johnson JP : A critical appraisal of syrinx cavity shunting procedures. J Neurosurg 89 : 382-388, 1998 https://doi.org/10.3171/jns.1998.89.3.0382
  4. Cho KH, Iwasaki Y, Imamura H, Hida K, Abe H : Experimental model of posttraumatic syringomyelia : the role of adhesive arachnoiditis in syrinx formation. J Neurosurg 80 : 133-139, 1994 https://doi.org/10.3171/jns.1994.80.1.0133
  5. Hida K, Iwasaki Y, Imamura H, Abe H: Posttraumatic syringomyelia : its characteristic magnetic resonance imaging findings and surgical management. Neurosurgery 35 : 886-891; discussion 891, 1994 https://doi.org/10.1227/00006123-199411000-00012
  6. Hong SH, Jeong SK, Chung CK, Kim HJ : Treatment of syringomyelia with consideration on its pathophysiology. J Korean Neurosurg Soc 31 : 388-391, 2002
  7. Klekamp J : The pathophysiology of syringomyelia -historical overview and current concept. Acta Neurochir (Wien) 144 : 649-664, 2002 https://doi.org/10.1007/s00701-002-0944-3
  8. Koyanagi I, Iwasaki Y, Hida K, Houkin K : Clinical features and pathomechanisms of syringomyelia associated with spinal arachnoiditis. Surg Neurol 63 : 350-355; discussion 355-356, 2005 https://doi.org/10.1016/j.surneu.2004.05.038
  9. Lee CW, Kim YS, Lee JS, Park MS, Ha HG, Kim JS : Syringopleural shunt for failed syringosubarachnoid shunt in posttraumatic Syringomyelia. J Korean Neurosurg Soc 30 : 633-637, 2001
  10. Lee JH, Chung CK, Kim HJ : Decompression of the spinal subarachnoid space as a solution for syringomyelia without Chiari malformation. Spinal Cord 40 : 501-506, 2002 https://doi.org/10.1038/sj.sc.3101322
  11. Lee TT, Alameda GJ, Camilo E, Green BA : Surgical treatment of post-traumatic myelopathy associated with syringomyelia. Spine 26 : S119-S127, 2001 https://doi.org/10.1097/00007632-200112151-00020
  12. Levi AD, Sonntag VK : Management of posttraumatic syringomyelia using an expansile duraplasty. A case report. Spine (Phila Pa 1976) 23 : 128-132, 1998 https://doi.org/10.1097/00007632-199801010-00026
  13. Rossier AB, Foo D, Shillito J, Dyro FM : Posttraumatic cervical syringomyelia. Incidence, clinical presentation, electrophysiological studies, syrinx protein and results of conservative and operative treatment. Brain 108 : 439-461, 1985 https://doi.org/10.1093/brain/108.2.439
  14. Umbach I, Heilporn A : Review article : post-spinal cord injury syringomyelia. Paraplegia 29 : 219-221, 1991 https://doi.org/10.1038/sc.1991.32
  15. Wiart L, Dautheribes M, Pointillart V, Gaujard E, Petit H, Barat M : Mean term follow-up of a series of post-traumatic syringomyelia patients after syringo-peritoneal shunting. Paraplegia 33 : 241-245, 1995 https://doi.org/10.1038/sc.1995.55
  16. Williams B : Pathogenesis of post-traumatic syringomyelia. Br J Neurosurg 6 : 517-520, 1992 https://doi.org/10.3109/02688699209002367
  17. Williams B : Post-traumatic syringomyelia, an update. Paraplegia 28 : 296-313, 1990 https://doi.org/10.1038/sc.1990.39
  18. Williams B, Terry AF, Jones F, McSweeney T : Syringomyelia as a sequel to traumatic paraplegia. Paraplegia 19 : 67-80, 1981 https://doi.org/10.1038/sc.1981.18

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