Post-traumatic syringomyelia following complete neurological recovery

Area of Science:

• Neurology
• Neurosurgery
• Spinal Cord Injury Research

Background:

• Spinal cord injuries (SCI) can present with initial recovery followed by delayed deterioration.
• Syringomyelia, the formation of fluid-filled cavities within the spinal cord, is a known complication of SCI.

Observation:

• A 52-year-old male with a history of cervical SCI (initially ASIA C, improved to ASIA E) developed new pain and neurological deficits nine years post-injury.
• Imaging revealed a syringomyelic cavity extending from C4 to C7, leading to progressive neurological decline.
• Despite surgical intervention with a syringo-subarachnoid shunt, the patient's condition worsened to a complete ASIA A lesion below C4.

Findings:

• The development of a post-traumatic syringomyelic cavity is associated with late-onset neurological deterioration.
• Even patients with initial significant neurological recovery (ASIA E) are susceptible to these delayed complications.
• Surgical management of syringomyelia in this context did not prevent further neurological decline.

Implications:

• This case underscores the necessity of long-term surveillance for syringomyelia in SCI survivors, particularly those experiencing late neurological decline.
• Understanding the pathogenesis of post-traumatic syringomyelia is crucial for developing effective preventative and therapeutic strategies.
• The findings suggest that syringomyelia can undermine even seemingly complete initial recovery from spinal cord injury.