Treatment of posttraumatic syringomyelia

Objective: to analyze the surgical treatment outcomes in patients with posttraumatic syringomyelia in «National medical surgical  center n.a. N.I. Pirogov» and to determine the optimal strategy for treatment of such patients.

Material and methods. Authors treated 44 patients with posttraumatic syringomyelia (PTS) from 2010 till 2016 yy., among  them 28 patients were operated on. Follow-up was from 11 months  (minimal) to 54 months (maximal). Age of patients varied from 15  till 58 years old (mean age — 38,7±4,8 years). The estimation of neurological status was done preoperatively, in 4 months after  operation and every 6-12 months postoperatively according to  Karnofsky scale, Japanese Orthopaedic Association (JOA), functional  classification of McCormick, Visual Analogue Scale (VAS) — in the case of pain syndrome. The examination of all patients in pre-and postoperative period includes the following methods: plain  spondylography in two routine projections, spinal CT and spinal MRI. Classification of Klecamp J. was used for evaluation of severity of arachnoid cicatrical tissue.

Results. Patients were divided into two groups for estimation of surgical operation results. The mean score according to Karnofsky  scale was 76,2 preoperatively and in 12 months after operation —  82,7 among patients with uncomplicated spinal trauma. Patients’  condition according to JOA before operation was 10,9 scores, after operation — 14,6; mean value according to McCormic scale  before operation — 2,4 degree, after operation — 1,6 degree. Mean  degree of arachnopathy in this group of patients was 1,5. The  syringomyelic cyst decreased almost twice in 1 year after operation according to MRI (mean Vaquero index decreased from 42,5 till 23,5%). The improvement of condition was seen at 10 (62,5%)  patients, stabilization - at 5 (31,3%) and the progression of disease  was seen at 1 (6,3%)patients. The mean score according to  Karnofsky scale was 62,4 preoperatively and in 12 months after  operation — 76,6 among patients with complicated spinal trauma.  Patients’ condition according to JOA before operation was 8,2 scores, after operation — 11,1; mean value according to McCormic scale before operation — 3,6 degree, after operation — 2,7 degree. Mean degree of arachnopathy in this group of patients was 2. The  syringomyelic cyst also decreased almost twice in 1 year after  operation according to MRI (mean Vaquero index decreased from  53,3 till 26,8%). The improvement of condition was seen at 4  (33,3%) patients, stabilization - at 6 (50%) and the progression of  disease was seen at 2 (16,7%) patients. The postoperative complications developed at 2 patients.

Conclusion. The operation should be directed on elimination of all factors which disturb the spinal fluid circulation. The shunt of  syringomyelic cyst is palliative operation with high risk of PTS  relapse. At the same time arachnolysis in addition to shunting of cyst may improve the surgery outcome due to decrease of spinal cord  volume and rapid clinical effect from operation. The usage of  selected strategy of PTS treatment in our group of patients allowed achieving stabilization of condition or even improvement in 89,2% patients.

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