The efficacy of surgical management in post traumatic syringomyelia: A systematic review

Posttraumatic syringomyelia (PTS) is a rare complication arising from spinal cord injury (SCI), characterized by the emergence of a cavity filled with fluid within the spinal cord parenchyma. The management of PTS remains a subject of debate.

This study aimed to examine initial symptoms, surgical treatments, and surgical outcomes of PTS.Study Design/Setting: Systematic review.

Keywords were chosen according to MeSH and Emtree terms in the Medline and Embase databases, respectively, and systematically searched in the Medline and Embase databases until March 2023. Mechanism of injury, level of injury, past treatment history, procedure, surgical complications, follow-up time, sensory, motor, pain and other assessments before and after surgery as well as the overall outcome of the surgery were extracted. We stratified the findings into three sections: (a) findings from provided summary statistics in longitudinal and before-after studies, (b) findings from studies that provided detailed characteristics of patients, and (c) findings from case reports.

After evaluation of 3232 unique records, 68 articles were included in this systematic review. Data of 1175 patients were included from 37 longitudinal and before-after studies and 31 case-reports. The level of injury is predominantly thoracolumbar, and cyst sizes are generally larger than 1 centimeter. Our study found that surgical treatment of PTS leads to an overall improvement in signs and symptoms (range: 58.02-93.5%) particularly in sensory symptoms (range: 24.77-44.1%), motor function (range: 41.83-54.35%), pain (range: 54.2-56.31%) and spasticity symptoms (up to 54.4%) in the patients. These results, retrieved from before-after and longitudinal studies, were also confirmed by case-reports.

Surgical interventions, ranging from cyst removal to shunting procedures, showed overall effectiveness, with the majority of patients experiencing improved neurological symptoms, particularly in pain, motor weakness, and spasticity.