Progressive posttraumatic cystic myelopathy: neuroradiologic evaluation

Area of Science:

• Neurology
• Radiology
• Neurosurgery

Background:

• Posttraumatic cystic myelopathy is a complication of spinal cord injury.
• Symptomatic progression necessitates accurate diagnosis and timely intervention.

Purpose of the Study:

• To review neuroradiologic findings in patients with progressive posttraumatic cystic myelopathy.
• To evaluate the effectiveness of neuroradiologic algorithms in diagnosing cystic myelopathy.
• To correlate imaging findings with surgical outcomes.

Main Methods:

• Retrospective review of 25 symptomatic patients with surgically confirmed cystic myelopathy.
• Analysis of neuroradiologic algorithms used in the 1970s (myelography) and later (CT metrizamide myelography).
• Comparison of imaging findings with surgical confirmation of cysts.

Main Results:

• In the 1970s, 14 of 25 proven cysts were associated with enlarged spinal cords.
• CT metrizamide myelography showed contrast filling in 9 of 11 cysts within 2-4 hours.
• These cysts did not communicate with the subarachnoid space, suggesting transneural fluid migration.

Conclusions:

• Neuroradiologic evaluation is crucial for diagnosing cystic myelopathy.
• CT metrizamide myelography offers improved cyst visualization.
• Early diagnosis and surgical treatment (cyst-shunt) are vital for preserving neurological function.