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. 2022 Aug 1:13:900441.
doi: 10.3389/fneur.2022.900441. eCollection 2022.

Spinal Obstruction-Related vs. Craniocervical Junction-Related Syringomyelia: A Comparative Study

Chenghua Yuan  1   2   3   4   5 , Jian Guan  1   2   3   4   5 , Yueqi Du  1   2   3   4   5 , Zeyu Fang  1   2   3   4   5 , Xinyu Wang  1   2   3   4   5 , Qingyu Yao  1   2   3   4   5 , Can Zhang  1   2   3   4   5 , Shanhang Jia  1   2   3   4   5 , Zhenlei Liu  1   2   3   4   5 , Kai Wang  1   2   3   4   5 , Wanru Duan  1   2   3   4   5 , Xingwen Wang  1   2   3   4   5 , Zuowei Wang  1   2   3   4   5 , Hao Wu  1   2   3   4   5 , Zan Chen  1   2   3   4   5 , Fengzeng Jian  1   2   3   4   5
Affiliations

Spinal Obstruction-Related vs. Craniocervical Junction-Related Syringomyelia: A Comparative Study

Chenghua Yuan et al. Front Neurol. .

Abstract

Background: No prior reports have focused on spinal cord injury (SCI) characteristics or inflammation after destruction of the blood-spinal cord barrier by syringomyelia. This study aimed to determine the differences in syringomyelia-related central SCI between craniocervical junction (CCJ) syringomyelia and post-traumatic syringomyelia (PTS) before and after decompression.

Methods: In all, 106 CCJ, 26 CCJ revision and 15 PTS patients (mean history of symptoms, 71.5 ± 94.3, 88.9 ± 85.5, and 32.3 ± 48.9 months) between 2015 and 2019 were included. The symptom course was analyzed with the American Spinal Injury Association ASIA and Klekamp-Samii scoring systems, and neurological changes were analyzed by the Kaplan-Meier statistics. The mean follow-up was 20.7 ± 6.2, 21.7 ± 8.8, and 34.8 ± 19.4 months.

Results: The interval after injury was longer in the PTS group, but the natural history of syringomyelia was shorter (p = 0.0004 and 0.0173, respectively). The initial symptom was usually paraesthesia (p = 0.258), and the other main symptoms were hypoesthesia (p = 0.006) and abnormal muscle strength (p = 0.004), gait (p < 0.0001), and urination (p < 0.0001). SCI associated with PTS was more severe than that associated with the CCJ (p = 0.003). The cavities in the PTS group were primarily located at the thoracolumbar level, while those in the CCJ group were located at the cervical-thoracic segment at the CCJ. The syrinx/cord ratio of the PTS group was more than 75% (p = 0.009), and the intradural adhesions tended to be more severe (p < 0.0001). However, there were no significant differences in long-term clinical efficacy or peripheral blood inflammation markers (PBIMs) except for the red blood cell (RBC) count (p = 0.042).

Conclusion: PTS tends to progress faster than CCJ-related syringomyelia. Except for the RBC count, PBIMs showed no value in distinguishing the two forms of syringomyelia. The predictive value of the neutrophil-to-lymphocyte ratio for syringomyelia-related inflammation was negative except in the acute phase.

Keywords: CSF; biomarker; decompression; spinal cord injury; syringomyelia.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of 147 consecutive syringomyelia patients between 2015 and 2019.
Figure 2
Figure 2
(A) Changes in related symptoms of syringomyelia of different etiologies. (B) Survival curve of syringomyelia.
Figure 3
Figure 3
Changes in the size of the syrinx in syringomyelia of different etiologies before and after surgery.
Figure 4
Figure 4
Peripheral blood inflammatory markers in syringomyelia of different etiologies.
Figure 5
Figure 5
Left chart: Representative case from the CM group. A patient was found to have syringomyelia due to facial paralysis. (A) Schematic drawings of the foramen magnum region. Midsagittal T2-weighted MRI scans of the craniocervical region and CT scans suggested that there was no other instability or basilar invagination (B). The ratio of the syrinx/canal from A to B three (C) months after the initial surgery and 30 (D) months after the initial surgery. (E,F) A hypertrophic tonsil obstructing the foramen of Magendie. (G,H) The right posterior inferior cerebellar artery (PICA) (asterisk) obstructing the foramen of Magendie was lysed, and the tonsil was coagulated. Lt, Left tonsil; Rt, Right tonsil; M, Medulla oblongata. Middle chart: Representative case from the revision group. (A) Preoperative sagittal T2-weighted MRI showed a large syrinx. (B) 3 months, (C) 9 months, and (D) 3 years after the first surgery. (E) CT showed partial bone defects of the occipital bone and persistent syringomyelia. (F) Postoperative MRI 2 years after the second surgery showing obvious reduction of the syringx. (G,H) A hypertrophic tonsil obstructing the foramen of Magendie. (I,J) The PICA (asterisk) obstructing the foramen of Magendie was lysed, and the tonsil was coagulated. Lt, Left tonsil; Rt, Right tonsil; M, Medulla oblongata. Right chart: Representative case from the PTS group. (A) Postoperative sagittal T2-weighted MRI scan showed some oedema and internal fixation. (B–D) Sagittal T2-weighted MRI and CT after 2 years showed a large syrinx (up to C4 and down to L1) and an L1 compression fracture. (E–G) Myelography showed that the circulation of CSF was blocked at L1. (H,I) Postoperative sagittal T2-weighted MRI data showed obvious reduction of the syrinx. (J,K): Obvious adhesions around the spinal cord at L1 were removed intraoperatively.
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