title: Post-traumatic syringomyelia: outcome predictors.
abstract: OBJECTIVE
  To identify risk factors that predispose to post-traumatic syringomyelia (PTS) and describe the outcome of surgical management.
  
  
  METHODS
  Retrospective cohort study of 27 patients with post-traumatic syringomyelia. Spinal cord injury of these patients spanned the period from 1963 to 2008. All data were collected retrospectively using available medical records and radiological images.
  
  
  RESULTS
  There were 24 males and 3 females. The level of initial spine injury was thoracic in 21, cervical in 4, and lumbar in 2. The average age (±SD) at diagnosis of PTS was 40±13 years. The mean follow-up ±SD from injury was 18±11 years. On admission after injury, there were 14 patients with American Spinal Injuries Association (ASIA) disability scores of A, 3 with ASIA C, and 10 with ASIA score of D. At the time of diagnosis of PTS, local kyphosis at the site of injury measured 28±12°, and the residual canal was 67±19% compared to the average rostral and caudal anteroposterior diameter. Fourteen patients underwent a single operation for PTS, and 13 needed two or more procedures. In the 11 patients in whom the initial surgery included a duraplasty, 3 required reoperation for unsuccessful reduction in the size of the syrinx and failure to improve symptoms. In the 16 patients in whom the initial procedure was that of a shunt alone, 10 required revision (p=0.0718 rate of revision between shunting and duraplasty). As a result of treatment for PTS, improvement in symptoms of PTS occurred in 14, symptoms were unchanged in 10, and progressed in 3. In the 11 patients with sequential MRI scans, a significant correlation was shown between the reduction in the size of the syrinx and clinical improvement (p<0.001).
  
  
  CONCLUSIONS
  PTS is often the result of severe spinal cord injuries, with over half of patients having an ASIA disability score of A. Our review corroborates other published reports showing that PTS is associated with significant deformity and stenosis. Irrespective of treatment, over half of the patients required reoperation for their PTS. Duraplasty and arachnolysis are the preferred treatment for PTS over shunting alone. Treatment was associated with cessation of symptoms or improvement in nearly 90% of the patients.
authors.affiliation: Neurochirurgien et chirurgien de la colonne, Hôpital de Hull, CSSSG 116, Boulevard Lionel-Émond, Gatineau (Québec) J8Y 1W7, Canada.
authors.forename: Youssef
authors.initials: Y
authors.lastname: Karam
authors.affiliation: Department of Neurosurgery, University of Iowa Carver College of Medicine, 200 Hawkins Dr, Iowa City, IA 52242, USA. Electronic address: patrick-hitchon@uiowa.edu.
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Hitchon
authors.affiliation: Department of Neurosurgery, University of Iowa Carver College of Medicine, 200 Hawkins Dr, Iowa City, IA 52242, USA.
authors.forename: Nakhle E
authors.initials: NE
authors.lastname: Mhanna
authors.affiliation: Department of Neurology and Neurosciences, Rutgers-New Jersey Medical School, 185 S Orange Ave, Newark, NJ 07103, USA.
authors.forename: Wenzhuan
authors.initials: W
authors.lastname: He
authors.affiliation: Department of Neurosurgery, University of Iowa Carver College of Medicine, 200 Hawkins Dr, Iowa City, IA 52242, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Noeller
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012086:Reoperation; D012307:Risk Factors; D013119:Spinal Cord Injuries / Q000150:complications*; D013595:Syringomyelia / Q000150:complications / Q000209:etiology / Q000601:surgery*; D013997:Time Factors
keywords: Duraplasty; Posttraumatic syringomyelia; Spinal cord injury; Spinal trauma; Syrinx