Aspectos epidemiológicos da siringomielia pós-traumática em uma coorte de 19 anos em unidade de reabilitação

Abstract

Patients with spinal cord injury (SCI) may develop late neurological complications directly related to the injury. Differential diagnoses should be considered in the event of worsening of neurological function. Posttraumatic syringomyelia (PTS) is a potentially serious complication of SCI in which a cyst forms within the spinal cord probably caused by alterations in cerebrospinal fluid (CSF) flow. PTS occurs in 4?51% of SCI patients according to heterogeneous small studies. Objective: To determine the prevalence, clinical and radiological risk factors, and surgical management of PTS in a 19-year cohort of SCI patients treated at a SCI rehabilitation center. Methods: Retrospective study of SCI patients in whom PTS was radiologically confirmed between December 2018 and January 2000. 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. [resumo fornecido pelo autor]