Impact of cordectomy as a treatment option for posttraumatic and non-posttraumatic syringomyelia with tethered cord syndrome and myelopathy

Clinical article

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  • 1 Department of Neurosurgery, Cantonal Hospital, St. Gallen;
  • 2 Swiss Paraplegic Centre, Nottwil, Switzerland; and
  • 3 Department of Neurosurgery, Heinrich Heine University, Düsseldorf, Germany
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Object

Spinal cordectomy has recently become more important in the treatment of end-stage posttraumatic or postoperative syringomyelia and arachnopathy as a last resort to manage ascending neurological dysfunction, spasticity, and pain in paraplegic patients. The aim in this study was to confirm a clinical benefit in strict indications for cordectomy.

Methods

Between February 2000 and September 2007, 15 spinal cordectomies were performed at the Department of Neurosurgery, Cantonal Hospital, St. Gallen. Indications for treatment were end-stage myelopathies caused by syringomyelia, tethered cord syndrome, and arachnopathy with progressive spasticity and pain or progressive upper-level neurological deficits related to the tethered cord syndrome. All patients had severe motor and sensory deficits with no residual voluntary function below the affected level.

Results

Fourteen of 15 patients showed stabilization or even an improvement in motor and sensory function. Four patients suffered from progressive spasticity and 3 from deterioration due to pain. There were no other adverse surgical events.

Conclusions

Cordectomy can be a useful instrument to preserve functions of the upper extremities and to improve spasticity and pain in patients with severe myelopathy and tethered cord, syringomyelia, or arachnopathy of various etiologies.

Abbreviations used in this paper: ASIA = American Spinal Injury Association; VAS = visual analog scale.

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Contributor Notes

Address correspondence to: Christian Ewelt, M.D., Department of Neurosurgery, Heinrich-Heine University, Moorenstrasse 5, D-40225 Düsseldorf, Germany. email: christian.ewelt@gmx.net.
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