Post-traumatic syringomyelia refractory to surgical intervention: a series of cases on recurrent syringomyelia

Abstract

Objective: The objective of this study was to analyze a series of traumatic spinal cord injury (SCI) patients with a diagnosis of syrinx who had recurrence of symptomatic syrinx following surgical intervention.

Design: This is a patient series.

Setting: The study was conducted in an acute inpatient rehabilitation facility.

Participants: Participants included patients (N=6) with post-traumatic syringomyelia (PTS) who had recurrent syrinx despite surgical repair.

Interventions: Not applicable.

Main outcome measures: The main outcome measures were time period between injury and clinical manifestations of syringomyelia, time to recurrence and presenting symptoms.

Results: Among the six patients, there is great variability between time of the initial SCI and the development of syrinx. In terms of time periods between diagnosis of syrinx and recurrence of syrinx, there is also some variability (ranging from 6 to 936 weeks). The median length of time to recurrence was 104 weeks. In all cases, the presenting symptom was ultimately weakness, and in most cases it was associated with rising sensory deficits. Notably, all patients were male, aged 31-55 years, had suffered diffuse traumatic SCI and four of six patients lost the ability to ambulate because of syrinx formation.

Conclusions: This series suggests that there may be risk factors for developing post-traumatic syringomyelia. We question whether there is a relationship between American Spinal Injury Association Impairment Scale grade and recurrence of PTS. We need to look closely at these patients to see whether there are modifiable risk factors that may minimize their chance of developing PTS. Once these are identified, there may be a role in routine screening of all patients and particularly those who may be at an increased risk for PTS to avoid loss of ambulatory function.