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Vol. 35. Issue 6.
Pages 311-318 (November - December 2024)
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Vol. 35. Issue 6.
Pages 311-318 (November - December 2024)
Special article
Epidemiological aspects of syringomyelia in a 19-year old cohort of spinal cord injury patients
Aspectos epidemiológicos de la siringomielia en una cohorte de 19 años de pacientes con lesión de la médula espinal
Vitor Viana Bonan de Aguiara,
Corresponding author
vitorvbonan@gmail.com

Corresponding author.
, Giovani Batistaa, Ricardo Geppa, Asdrubal Falavignab
a Sarah Network of Rehabilitation Hospitals, Brazil
b University Caxias do Sul, Brazil
Article information
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Tables (4)
Table 1. Clinical and demographic characteristics of patients with posttraumatic syringomyelia (n = 85).
Table 2. Indications for surgical treatment and surgical approach for patients with posttraumatic syringomyelia (n = 48).
Table 3. Complications observed after surgical procedures in patients with posttraumatic syringomyelia.
Table 4. Reoperation rates for PTS surgery.
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Abstract
Objective

To determine the prevalence, clinical and radiological risk factors, and surgical management of post-traumatic syringomyelia (PTS) in a 19-year cohort study of Spinal Cord Injury (SCI) patients treated at a SCI rehabilitation center.

Methods

Retrospective study of SCI patients in whom PTS was radiologically confirmed between January 2000 and December 2018. Protocols for assessing signs and symptoms of PTS were applied prior to PTS diagnosis and treatment and later at neurosurgical and rehabilitation reviews. The variables analyzed were prevalence, demographic data, trauma event, clinical and radiological risk factors, location and size of the syrinx, and effectiveness of the surgical procedures.

Results

Over the 19-year period, review of 920 SCI patients revealed 85 patients who met the clinical and neuroradiological criteria for the diagnosis of PTS and who were prospectively followed. Road traffic accidents were the leading cause of injury (n = 58; 68.2%), syringomyelia was most commonly observed in the thoracic spine (n = 56; 65.9%), and upper extremity paresis was the most common indication for surgical treatment (n = 27; 45%). Surgical treatment was indicated in 48 patients and the operative procedures included 29 syringopleural shunts (60.4%), 17 adhesiolysis (35.4%), and two syringosubarachnoid shunts (4.1%). The prevalence of PTS was 9% and was higher in patients with ASIA impairment scale grade A injuries. Most patients with PTS (63/85, 74.1%) were treated surgically at the time of injury. There was a significant reduction both in the extent (p = 0.05) and largest area (p = 0.001) of the syrinx after surgical treatment. Reoperation rates were 47% and 37.9% for adhesiolysis and syringopleural shunting, respectively.

Conclusion

Follow-up and routine clinical examination of SCI patients is critical for the diagnosis of PTS in patients with late neurological deterioration. Surgical treatment has a positive impact in reducing the size of the syrinx as seen on postoperative MRI.

Keywords:
Spinal cord injury
Syringomyelia
Magnetic resonance imaging
Adhesiolysis
Syringopleural shunting
Abbreviations:
AIS
ASIA
CNS
CSF
CT
MRI
PTS
SCI
Resumen
Objetivo

Determinar la prevalencia, los factores de riesgo clínicos y radiológicos y el tratamiento quirúrgico de la siringomielia postraumática (SPT) en un estudio de cohorte de 19 años de pacientes con Lesion medular Espinal (LME) tratados en un centro de rehabilitación de LME.

Métodos

Estudio retrospectivo de pacientes con LME en quienes se confirmó radiológicamente el SPT entre enero de 2000 y diciembre de 2018. Se aplicaron protocolos para evaluar los signos y síntomas del SPT antes del diagnóstico y tratamiento del SPT y posteriormente en las revisiones neuroquirúrgicas y de rehabilitación. Las variables analizadas fueron prevalencia, datos demográficos, evento traumático, factores de riesgo clínicos y radiológicos, ubicación y tamaño de la siringe y efectividad de los procedimientos quirúrgicos.

Resultados

Durante el período de 19 años, la revisión de 920 pacientes con LME reveló que 85 pacientes cumplían con los criterios clínicos y neurorradiológicos para el diagnóstico de SPT y que fueron seguidos prospectivamente. Los accidentes de tráfico fueron la principal causa de lesiones (n = 58; 68,2%), la siringomielia se observó con mayor frecuencia en la columna torácica (n = 56; 65,9%) y la paresia de las extremidades superiores fue la indicación más común de tratamiento quirúrgico (n = 27; 45%). Se indicó tratamiento quirúrgico en 48 pacientes y los procedimientos quirúrgicos incluyeron 29 derivaciones siringopleurales (60,4%), 17 adhesiolisis (35,4%) y dos derivaciones siringosubaracnoideas (4,1%). La prevalencia de SPT fue del 9% y fue mayor en pacientes con lesiones de grado A en la escala de deterioro de ASIA. La mayoría de los pacientes con SPT (63/85, 74,1%) fueron tratados quirúrgicamente en el momento de la lesión. Hubo una reducción significativa tanto en la extensión (p = 0,05) como en el área más grande (p = 0,001) de la siringe después del tratamiento quirúrgico. Las tasas de reoperación fueron del 47% y del 37,9% para adhesiolisis y derivación siringopleural, respectivamente.

Conclusiones

El seguimiento y el examen clínico de rutina de los pacientes con LME es fundamental para el diagnóstico de SPT en pacientes con deterioro neurológico tardío. El tratamiento quirúrgico tiene un impacto positivo en la reducción del tamaño de la siringe, como se observa en la resonancia magnética posoperatoria.

Palabras clave:
Lesión de la médula espinal
Siringomielia
Resonancia magnética
Adhesiolisis
Derivación siringopleural

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