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Progressive posttraumatic myelomalacic myelopathy: imaging and clinical features
S Falcone1, R M Quencer, B A Green
1Department of Radiology, University of Miami/Jackson Memorial Medical Center.
AJNR. American Journal of Neuroradiology
|April 1, 1994
Summary
Progressive posttraumatic myelomalacic myelopathy (PPMM) causes worsening spinal cord injury symptoms. Surgical lysis of adhesions improves outcomes, distinguishing it from cystic myelopathy.
Area of Science:
- Neurosurgery
- Neurology
- Radiology
Background:
- Progressive posttraumatic myelomalacic myelopathy (PPMM) is an underrecognized cause of worsening neurological deficits after spinal cord injury.
- It can mimic other post-injury complications, necessitating accurate diagnosis and management.
Purpose of the Study:
- To delineate the imaging features, surgical management, and clinical outcomes of patients with PPMM.
- To differentiate PPMM from progressive posttraumatic cystic myelopathy (PPCM).
Main Methods:
- Retrospective review of 10 patients with PPMM, including clinical data, imaging (MRI), and surgical outcomes.
- Analysis of preoperative and postoperative MRI for signal abnormalities and cord tethering.
- Intraoperative sonography utilized in all cases.
Main Results:
- Common symptoms include motor loss, sensory changes, spasticity, autonomic dysreflexia, and bowel/bladder dysfunction.
- MRI revealed intramedullary signal changes, cord tethering, and ill-defined lesions.
- Postoperative MRI showed spinal cord untethering, and 9/10 patients improved neurologically after surgery.
Conclusions:
- PPMM shares imaging and clinical features with PPCM, but intraoperative sonography can differentiate them.
- Surgical lysis of intradural adhesions in PPMM leads to symptom improvement.
- Accurate diagnosis and surgical approach are critical for managing PPMM.