Posttraumatic Spinal Cord Tethering and Syringomyelia: A Retrospective Investigation of Patients With Progressive Disease and Surgical Revisions.

Background: Spinal cord tethering and syringomyelia after trauma are well-known pathologies in patients suffering from spinal cord injury (SCI). In symptomatic cases, various surgical options are available, but untethering and expansion duraplasty is the currently preferred treatment strategy. However, patient outcomes are usually limited by rather high rates of surgical revisions. The aim of the present study was to identify risk factors in SCI patients who underwent multiple surgeries for symptomatic spinal cord tethering and syringomyelia.

Methods: We retrospectively investigated 25 patients who received at least 2 untethering surgeries of the spinal cord. All patients were treated by untethering and expansion duraplasty and/or clinically followed between 2012 and 2022 at the Swiss Paraplegic Center.

Results: A higher location of SCI correlates with a more rapid development of symptomatic spinal cord retethering in need of surgical revision (r = 0.406 and P = 0.044). Interestingly, the extent of spinal cord tethering is lower in those patients who underwent an early surgical intervention (r = 0.462 and P = 0.030), which points toward an increased vulnerability of the spinal cord at higher levels. Ninety-two percent of the patients displayed a potentially chronic inflammatory condition with a mean level of C-reactive protein of 28.4 ± 4.1 mg/L, while the white blood cell count was identified as an independent predictor for surgical interventions in symptomatic cases.

Conclusions: Revision surgery in posttraumatic spinal cord tethering and syringomyelia patients is associated with the location of SCI and the extent of spinal cord tethering. It appears that chronic inflammatory conditions might play an important role in promoting spinal cord retethering and thus warrant further investigation.

Clinical relevance: SCI patients with chronic inflammatory conditions and SCI at upper levels should be clinically monitored more carefully as they appear to be more susceptible to progressive forms of posttraumatic spinal cord tethering and syringomyelia.

Level of evidence: 3: