Does direct surgical decompression after traumatic spinal cord injury influence post-traumatic syringomyelia rates? An 18-year single-centre experience.

OBJECTIVE: Risk factors for post-traumatic syringomyelia (PTS) development after traumatic spinal cord injury (tSCI) are incompletely understood. This study aimed to investigate the influence of direct surgical decompression after tSCI, as well as demographic, clinical and other management-related factors, on rates of PTS development.

METHODS: A single-centre case-control study was conducted on patients who presented with tSCI to a tertiary referral centre over an 18-year period and received adequate follow-up. Cases were defined by both clinical suspicion and radiological evidence of PTS. Demographic, clinical and management-related data were collected and a multivariable logistic regression analysis performed.

RESULTS: 286 patients were analysed, of whom 33 (11.5%) demonstrated PTS. Direct surgical decompression with or without stabilisation was performed in 190/286 patients, stabilisation alone in 47 and non-surgical management in 49. On multivariable analysis, no significant influence on PTS risk was demonstrated for method of acute management (p>0.05). A ten-year increase in age at injury was shown to decrease PTS rates by 0.72 (p=0.01). Neurologically complete injury was associated with an increased rate of PTS, though this association did not achieve significance (p=0.08). When only surgically-managed patients were considered (n=237), no significant influence on PTS rates was demonstrated for anterior decompression (aOR=1.13, 95% CI=0.34-3.74, p=0.84) and for stabilisation alone (aOR=1.19, 95% CI=0.39-3.61, p=0.76) relative to posterior decompression.

CONCLUSIONS: Direct surgical decompression after tSCI was not demonstrated to significantly influence rates of PTS development. Age at injury and severity of injury should be considered as risk factors for PTS on follow-up.