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Posttraumatic Tethered Spinal Cord & Syringomyelia

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Information for people about a tethered spinal cord and syringomyelia

Posttraumatic Tethered Spinal Cord & Syringomyelia

What is Tethered Spinal Cord?

Posttraumatic tethered spinal cord is a condition that can occur following spinal cord injury and can result in progressive deterioration of the spinal cord. Posttraumatic tethered spinal cord is a condition which occurs following injury to the spinal cord where scar tissue forms and tethers or holds the spinal cord to the soft tissue covering which surrounds it called the dura. This scar tissue prevents the normal flow of spinal fluid around the spinal cord and impedes the normal motion of the spinal cord. Myelomalacic (softening or increased water content) changes may then occur in the spinal cord. Tethering of the spinal cord has been suggested as a pathophysiological cause for the formation of cysts or syrinxs in the spinal cord. A posttraumatic tethered cord can occur without evidence of syringomyelia; however, in our experience, post-traumatic cystic or syrinx formation will not occur without some degree of tethering of the spinal cord. Posttraumatic tethered cords and syringomyelia are treated surgically when a complex of clinical symptoms occurs.

Signs and Symptoms

The clinical symptoms for a posttrautic tethered cord may include:

  • progressive loos of sensation or strength
  • hyperhidrosis (profuse sweating)
  • spasticity, pain, autonomic dysreflexia (labile blood pressure)
  • Horner's syndrome (dilated pupil).

Deterioration of the spinal cord related to these myelopathies can occur above and/or below the level of injury. Sensory and motor symptoms are a result of changes occurring in the spinal cord, and are directly related to the specific location of these changes in the spinal cord. In other words, if changes occur above the level of injury preserved function is affected. Patients may experience a slow and progressive loss of the ability to feel hot or cold water on their skin or develop hypersensitivity, so that touching the skin causes pain. This change in sensation occurs in areas where the patient previously had normal or impaired sensation. Loss of strength can be described by patients as the inability to use certain muscles that were previously present and/or the development of fatiguing muscle groups which interferes with function. For instance, patients often say they have difficulty wheeling their chair the same distances or performing repetitive motions for the same amount of time.

Hyperhidrosis or profuse sweating can occur anywhere on the body and occurs without a specific cause. Patients can develop the new onset of spasticity, or spasticity can worsen, unrelated to other issues such as a plugged catheter, skin breakdown, or bowel program.

The onset of new pains or the worsening of pains that were present at the time of injury may occur. Secondary to these pains, patients report various types of symptoms, including burning, stinging, stabbing, sharp, shooting, electrical, crushing, squeezing, tight, vise-like cramping pains. These pains generally occur in areas where patients have lost sensation or where sensation sense is not normal.

Autonomic dysreflexia is described as an over-activity of the autonomic nervous system in response to stimuli. This can result in rapid swings in blood pressure, blotchy skin or goose bumps and sweating. These symptoms can be present unrelated to a stimulus or begin occurring at times when they had not before (i.e., bowel programs).

The Horner's syndrome usually presents as one pupil appearing smaller than the other pupil, and can switch from side to side. This symptom is not always present and can occur at the time of a spinal cord injury.

Surgical Treatment for Posttraumatic Tethered Spinal Cord

Surgical intervention for posttraumatic tethered cord is an option when patients are experiencing progressive loss of sensory and/or motor function. If medical management of pain, spasticity, autonomic dysreflexia, and/or hyperhidrosis has been unsuccessful, surgical intervention may be considered. The surgery involves removing bone in the back of the spine to get to the dura- the covering around the spinal cord. We use ultrasound to identify the area of scar tissue formation and then open the dura and release the bands of scar tissue to restore spinal fluid flow and motion of the spinal cord. The dura is then closed using an expansion duraplasty- a graft placed to enhance the dural space and decrease the risk of re-scarring.


What is Posttraumatic Syringomyelia (cyst/syrinx)?

Posttraumatic Syringomyelia is a condition that can occur following spinal cord injury and can result in progressive deterioration of the spinal cord. Postraumatic syringomyelia involves development of a fluid-filled cavity (called a cyst or syrinx) within the spinal cord following a spinal cord injury. Tethering or scarring of the spinal cord has been suggested as a pathophysiological cause for the formation of a syrinx or cyst in the spinal cord.

A posttraumatic tethered cord can occur without evidence of syringomyelia; however, in our experience, posttraumatic syrinx or cystic formation will not occur without some degree of tethering of the spinal cord. Posttraumatic syringomyelia is treated surgically when a complex of symptoms occurs.

Signs and Symptoms

The clinical symptoms for syringomyelia may include:

  • Progressive loss of sensation or strength
  • Hyperhidrosis (profuse sweating)
  • Spasticity, pain, autonomic dysreflexia (labile blood pressure)
  • Horner's syndrome (dilated pupil)

Deterioration of the spinal cord related to these myelopathies can occur above and/or below the level of injury. Sensory and motor symptoms are a result of changes occurring in the spinal cord, and are directly related to the specific location of these changes in the spinal cord. In other words, if changes occur above the level of injury preserved function is affected. Patients may experience a slow and progressive loss of the ability to feel hot or cold water on their skin or develop hypersensitivity, so that touching the skin causes pain. This change in sensation occurs in areas where the patient previously had normal or impaired sensation. Loss of strength can be described by patients as the inability to use certain muscles that were previously present and/or the development of fatiguing muscle groups which interferes with function. For instance, patients often say they have difficulty wheeling their chair the same distances or performing repetitive motions for the same amount of time.

Hyperhidrosis or profuse sweating can occur anywhere on the body and occurs without a specific cause. Patients can develop the new onset of spasticity, or spasticity can worsen, unrelated to other issues such as a plugged catheter, skin breakdown, or bowel program.

The onset of new pains or the worsening of pains that were present at the time of injury may occur. Secondary to these pains, patients report various types of symptoms, including burning, stinging, stabbing, sharp, shooting, electrical, crushing, squeezing, tight, vise-like cramping pains. These pains generally occur in areas where patients have lost sensation or where sensation sense is not normal.

Surgical Treatment for Posttraumatic Syringomyelia

Surgical intervention for syringomyelia is an option when patients are experiencing progressive loss of sensory and/or motor function. If medical management of pain, spasticity, autonomic dysreflexia, and/or hyperhidrosis has been unsuccessful, surgical intervention may be considered. The surgery involves removing bone in the back of the spine to get to the dura- the covering around the spinal cord. We use ultrasound to evaluate the extent and size of the syrinx. As in the spinal cord untethering surgery, we release the scar tissue from the surrounding dura to restore spinal fluid flow and motion. We again ultrasound to evaluate the syrinx. In our experience, 80% of the time the syrinx collapses with the untethering; 20% of the time a small tube called a shunt is placed within the syrinx cavity to drain the fluid. Like the untethering surgery, the dura is then closed using an expansion duraplasty- a graft placed to enhance the dural space and decrease the risk of re-scarring.

The Take Home Message:

People with SCI need to be aware of changes in sensation, function, pain, and strength. With any change, speak with your doctor and report changes early. Be proactive in your health – losing function or sensation can lead to other problems.

For information about Craig Hospital's Neurosurgical Program for Syringolmyelia and Tethered Spinal Cords visit: http://craighospital.org/programs/rehabilitative-neurosurgery

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Revised: 1/2017


References:

  1. Falci, S. P., Indeck, C., & Lammertse, D. P. (2009). Posttraumatic spinal cord tethering and syringomyelia: surgical treatment and long-term outcome. Journal of Neurosurgery: Spine, 11(4), 445-460.
  2. Reference: Falci, S., Indeck C., et al. Posttraumatic Spinal Cord Tethering and Syringomyelia: Surgical Treatment and Long-Term Outcome. Journal of Neurosurgery, Spine. 2009; 11(4):445- 460.

This resource is provided as a courtesy of Craig Hospital. For more information, contact the Craig Hospital Nurse Advice Line at 1-800-247-0257.

Disclaimer: The content in this document is intended for general informational purposes only and is not a substitute for professional medical advice or treatment for specific medical conditions. No professional relationship is implied or otherwise established by reading this document. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Many of the resources references are not affiliated with Craig Hospital. Craig Hospital assumes no liability for any third party material or for any action or inaction taken as a result of any content or any suggestions made in this document and should not be relied upon without independent investigation. The information on this page is a public service provided by Craig Hospital and in no way represents a recommendation or endorsement by Craig Hospital.