Reintervention rate of arachnolysis versus shunting for nonforaminal syringomyelia

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  • 1 Department of Neurosurgery, French National Center for Chiari and Syringomyelia (C-MAVEM), Bicêtre Hospital, AP-HP, Paris-Saclay University, Paris; and
  • 2 Medical School, Paris-Saclay University, Le Kremlin-Bicêtre, Paris, France
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OBJECTIVE

Surgical treatment for nonforaminal syringomyelia related to spinal arachnoiditis is still controversial. The authors sought to assess respective outcomes and rates of reintervention for shunting and spinal cord untethering (arachnolysis) in spinal arachnoiditis with syringomyelia.

METHODS

This retrospective cohort study was conducted at a single reference center for syringomyelia. Patients undergoing arachnolysis and/or shunting interventions for nonforaminal syringomyelia were screened.

RESULTS

The study included 75 patients undergoing 130 interventions. Arachnolysis without shunting was performed in 48 patients, while 27 patients underwent shunting. The mean follow-up between the first surgery and the last outpatient visit was 65.0 months (range 12–379 months, median 53 months). At the last follow-up, the modified McCormick score was improved or stabilized in 83.4% of patients after arachnolysis versus 66.7% after shunting. Thirty-one (41.3%) patients underwent reintervention during follow-up, with a mean delay of 33.2 months. The rate of reintervention was 29.2% in the arachnolysis group versus 63.0% in the shunting group (chi-square = 8.1, p = 0.007). However, this difference was largely driven by the extension of the arachnoiditis: in patients with focal arachnoiditis (≤ 2 spinal segments), the reintervention rate was 21.6% for arachnolysis versus 57.1% for shunting; in patients with extensive arachnoiditis, it was 54.5% versus 65.0%, respectively. Survival analysis assessing the time to the first reintervention demonstrated a better outcome in both the arachnolysis (p = 0.03) and the focal arachnoiditis (p = 0.04) groups.

CONCLUSIONS

Arachnolysis led to fewer reinterventions than shunting in patients with nonforaminal syringomyelia. There was a high risk of reintervention for patients with extensive arachnopathies, irrespective of the surgical technique.

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Contributor Notes

Correspondence Steven Knafo: Bicêtre Hospital, Le Kremlin-Bicêtre, Paris, France. steven.knafo@aphp.fr.

INCLUDE WHEN CITING Published online February 5, 2021; DOI: 10.3171/2020.8.SPINE20928.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

  • 1

    Klekamp J . How should syringomyelia be defined and diagnosed? World Neurosurg. 2018;111:e729e745.

  • 2

    Heiss JD , Patronas N , DeVroom HL , Elucidating the pathophysiology of syringomyelia. J Neurosurg. 1999;91(4):553562.

  • 3

    Than KD , Mummaneni PV . Perspective: surgical options for adult syringomyelia. World Neurosurg. 2015;83(4):464465.

  • 4

    Ghobrial GM , Dalyai RT , Maltenfort MG , Arachnolysis or cerebrospinal fluid diversion for adult-onset syringomyelia? A systematic review of the literature. World Neurosurg. 2015;83(5):829835.

    • Search Google Scholar
    • Export Citation
  • 5

    Karam Y , Hitchon PW , Mhanna NE , Post-traumatic syringomyelia: outcome predictors. Clin Neurol Neurosurg. 2014;124:4450.

  • 6

    Aghakhani N , Baussart B , David P , Surgical treatment of posttraumatic syringomyelia. Neurosurgery. 2010;66(6):11201127.

  • 7

    Ushewokunze SOS , Gan YC , Phillips K , Surgical treatment of post-traumatic syringomyelia. Spinal Cord. 2010;48(9):710713.

  • 8

    Shrivastava RK , Epstein FJ , Perin NI , Intramedullary spinal cord tumors in patients older than 50 years of age: management and outcome analysis. J Neurosurg Spine. 2005;2(3):249255.

    • Search Google Scholar
    • Export Citation
  • 9

    Klekamp J , Batzdorf U , Samii M , Bothe HW . Treatment of syringomyelia associated with arachnoid scarring caused by arachnoiditis or trauma. J Neurosurg. 1997;86(2):233240.

    • Search Google Scholar
    • Export Citation
  • 10

    Bonfield CM , Levi AD , Arnold PM , Okonkwo DO . Surgical management of post-traumatic syringomyelia. Spine (Phila Pa 1976). 2010;35(21)(suppl):S245S258.

    • Search Google Scholar
    • Export Citation
  • 11

    Vaquero J , Martínez R , Salazar J , Santos H . Syringosubarachnoid shunt for treatment of syringomyelia. Acta Neurochir (Wien). 1987;84(3-4):105109.

    • Search Google Scholar
    • Export Citation
  • 12

    Klekamp J . Treatment of posttraumatic syringomyelia. J Neurosurg Spine. 2012;17(3):199211.

  • 13

    Klekamp J . Treatment of syringomyelia related to nontraumatic arachnoid pathologies of the spinal canal. Neurosurgery. 2013;72(3):376389.

    • Search Google Scholar
    • Export Citation

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