Treatment of Terminal Syringomyelia in Association with Tethered Cord Syndrome: Clinical Outcomes With and Without Syrinx Drainage

, , , , Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey

Neurosurg Focus. 2000;8(3) 

In This Article

Abstract and Introduction

Object. Current use of magnetic resonance (MR) imaging has led to increased awareness of the frequency of terminal syringomyelia in patients with tethered cord syndrome. However, that the surgical treatment of terminal syringomyelia is necessary remains unclear.
In this study the authors attempted to assess the clinical impact, if any, brought after syrinx decompression on the clinical outcome of tethered cord syndrome.
Methods. They randomly assigned 30 cases of pediatric tethered cord into two treatment groups: those in whom an untethering procedure was performed (Group I) and those in whom this procedure was combined with syrinx decompression (Group II). The 1-year follow-up clinical results obtained in the two groups, in correlation with MR imaging findings, were compared to evaluate the benefit of added syrinx drainage. Clinical follow-up evaluation revealed that surgical drainage of the syrinx, when combined with spinal cord untethering, resulted in better outcomes in terms of resolution of sensory deficits (p = 0.036) and bladder dysfunction (p = 0.05). The improvement in clinical outcome correlated with the radiologically documented resolution of the syrinx cavity; however, response rates of symptoms differed for each tethering subgroup.
Conclusions. Preliminary results of this study indicated that terminal syringomyelia should be considered as a comorbidity that contributes to the clinical outcome of patients with tethered cord syndrome. A better clinical outcome is achieved following successful decompression of the syrinx in addition to untethering the spinal cord. These findings emphasize the importance of recognizing, evaluating, and treating this pathological entity.

With the advent of MR imaging terminal syringomyelia, the segmental intramedullary cystic cavitation of the caudal third of the spinal cord,[19] became quite a common radiological finding in association with congenital spinal cord anomalies.[5,20,37,42] In recent studies the authors have described the overall clinical and radiological features of this pathological entity, documenting a prevalence of 22.5 to 53%, associated most often with tethered spinal cord.[6,8,19,30] However, little is known regarding the causal factors leading to the syrinx formation or the contribution of this added entity to the overall clinical picture. Furthermore, although a number of authors[6,24,45] have described the beneficial effect of performing syrinx drainage on the clinical outcome in patients with tethered cord syndrome, it is not clear whether surgical treatment of the syrinx is necessary, because the authors of these studies did not prospectively compare their results with a concurrent control group.

In this study we endeavor to assess the clinical impact, if any, of syrinx decompression on the surgical outcome. We performed a prospective evaluation of the clinical and radiological outcomes of patients who underwent an untethering procedure, with or without syrinx drainage. The 1-year follow-up clinical results obtained in these two groups, in association with the MR imaging-documented findings, were evaluated to determine the benefit of added syrinx drainage.