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

Crescenzo Capone; Denis Bratelj; Susanne Stalder; Phillip Jaszczuk; Marcel Rudnick; Rajeev K. Verma; Tobias Pötzel; Michael Fiechter

doi:10.14444/8716

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Rate of development of symptomatic spinal cord tethering and syringomyelia in patients with surgical revisions. The interval between spinal cord injury (SCI) and the first surgical intervention correlated with the location of the SCI lesion (panel A; P = 0.020) and with the extent of spinal cord tethering (panel B; P = 0.030). Furthermore, the velocity of development of spinal cord retethering was correlated to the segmental height of the SCI lesion (panel C; P = 0.044). The 95% confidence interval of the linear line fitting including the SE of regression is given for panels A–C. Regarding the location of SCI lesion, the vertebral segments are displayed in anatomical order from C0 to S1, while the displayed locations refer to the middle of the respective SCI lesion.

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Table 1

Patient baseline characteristics.

Characteristic	Cohort (n = 25)
Age SCI, y, mean ± SD	27.7 ± 2.3
Age at first surgery, y, mean ± SD	41.6 ± 2.3
Age at revision surgery, y, mean ± SD	47.9 ± 2.2
AIS grade A, n (%)	18 (72.0%)
Polytrauma, n (%)	23 (92.0%)
Chronic prostatitis and/or recurrent UTI, n (%)	23 (92.0%)
Pressure ulcers, n (%)	14 (56.0%)
Other inflammatory diseases, n (%)	12 (48.0%)
CRP, mg/L, mean ± SD	28.4 ± 4.1
WBC count, 10⁹/L, mean ± SD	7.7 ± 0.4

Abbreviations: AIS, ASIA impairment scale; CRP, C-reactive protein; SCI, spinal cord injury; UTI, urinary tract infection; WBC, white blood cell.
Note: Because only 3 of the 25 patients in this cohort were women, statistical comparison of the demographics between men vs women was not possible.

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Table 2

Stepwise linear regression models for the development of symptomatic spinal cord tethering and syringomyelia after trauma in need for surgical intervention (n = 25).

Stepwise Linear Regression Model	B Coefficient (SE)	P
Model 1
Age	0.478 (0.169)	0.013
Extent of spinal cord tethering/syringomyelia	0.396 (0.468)	0.034
Location of SCI	0.254 (NA)	0.200
Model 2
Location of SCI	0.621 (0.404)	0.002
WBC count	0.357 (1.032)	0.048
Age	0.319 (NA)	0.080
CRP	–0.103 (NA)	0.585

Abbreviations: CRP, C-reactive protein; NA, not applicable; SCI, spinal cord injury; WBC, white blood cell.
Note: Stepwise method was performed including the predictor variables age, location of SCI, and extent of spinal cord tethering/syringomyelia in model 1 and age, sex, location of SCI, CRP, and WBC in model 2.

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Table 3

Stepwise linear regression model for the development of symptomatic spinal cord retethering and syringomyelia after trauma in need for surgical revision (n = 25).

Stepwise Linear Regression Model	B-Coefficient (SE)	P
Location of SCI	0.406 (0.273)	0.044
Age	0.087 (NA)	0.718
Duraplasty (Gore-Tex)	−0.315	0.105
Duraplasty (polyesterurethane)	0.295	0.147
Duraplasty (bovine pericardium)	0.316	0.104

Abbreviations: NA, not applicable; SCI, spinal cord injury.
Note: Stepwise method was performed including the predictor variables age, type of duraplasty, and location of SCI.