Posttraumatic syringomyelia: Epidemiology, clinical aspects and outcome of a rare complication following traumatic spinal cord injury

Abstract

Background: Posttraumatic syringomyelia (PTS) can occur as a rare complication after traumatic spinal cord injury (tSCI) and in cases of delayed diagnosis could lead to disastrous deterioration of both motor and sensory neurological functions. Objective: To determine influencing factors causing PTS after tSCI. Material and methods: In a monocentric retrospective two-arm study all patients who were readmitted as inpatients due to increasing neurological impairment caused by PTS (n = 107) in the period between 1 October 1997 and 31 December 2012 were compared with a randomised group of tSCI patients without PTS (n = 1590) over the same time period. Results: Included in the study were 107 patients with an average age of 30.25 years (86 male and 21 female). The most frequent clinical symptoms were changes in sensitivity, pain perception and muscle strength. Within the PTS group, patients older than 30 years had a shorter interval between the onset of SCI and the diagnosis of PTS (p < 0.001). Both the study and control groups showed a significant age difference at the time of the accident (p < 0.001). In addition, the number of completely paraplegic (American Spinal Injury Association impairment scale AIS type A) patients was significantly higher within the PTS group (p < 0.001) and they also had remission to pedestrians significantly less frequently (p < 0.001). In addition, in a group comparison significantly different neurological levels of paralysis (p < 0.001) were observed at the time of discharge. Further results showed that younger patients with complete SCI lesions had a higher risk of developing PTS. Conclusion: The PTS is a rare but severe complication of tSCI, frequently followed by increasing impairment of sensibility, motor function and the autonomic nervous system. As the prognosis of the disease is highly influenced by the time point of the diagnosis, in suspected cases immediate presentation at a specialized center for paraplegic patients is necessary.