Spinal cord tethering after traumatic paraplegia with late neurological deterioration

The case of a 49-year-old man with traumatic complete T-5 paraplegia of 30 years' duration is presented. Over the last 10 years, he developed cervical myelopathy suggestive of syringomyelia. Work-up, including metrizamide myelography and delayed computerized tomography scanning, revealed an atrophic cord without a syrinx, and a complete block to contrast material at T-5. At operation, the cord was found to be tethered at the original injury site, and was released by transection. This resulted in immediate improvement in the somatosensory evoked potentials and marked postoperative clinical improvement. It is postulated that cord tethering can cause delayed myelopathy in patients with traumatic cord injury. Release of the tethered cord should be considered if a posttraumatic syrinx is not found.