New surgical approach for late complications from spinal cord injury

From October 2000 to March 2006, 23 patients were selected for surgery: three showed signs of syringomyelia, three presented with microcystic lesions, three presented with arachnoid cysts in different locations but always confluent to the scar area, and 14 showed evidence of tethered cords. The surgery consisted of laminectomy at four levels, followed by dural opening in order to remove all the arachnoiditis at the level of the scar and to remove the altered arachnoid and its cysts, at least at two levels above and below the lesion. The dentate ligaments were cut at all exposed levels.The patients had no postoperative problems and not only retained all neurological functions but also showed neurological recovery. According to the motor and sensory scale of the American Spinal Injury Association, the recoveries were motor 20.6% (P < 0.001), touch 15.6% ((P < 0.001) and pinprick 14.4% (P < 0.001). These patients showed no signs of relapse at 4–66 month follow-up.This alternative surgery resolved the pathologies provoking neurological deterioration by releasing the complete spinal cord at the level of the scar and the levels above and below it. It thus avoids myelotomies and the use of shunts and stents, which have a high long-term failure rate and consequent relapses. Nevertheless, this surgical procedure allows patients the chance to opt for any further treatment that may evolve in the future.Arachnoiditis is one of most important factors in late complications of spinal cord injury patients. It leads to intra-medullar lesions such as syringomyelia cysts and microcysts, or extra-medullar lesions such as tethered cords and arachnoid cysts. All these pathologies were well described and differ in their clinical manifestations and in the forms in which they could be diagnosed. Abnormalities common to all the pathologies include arachnoiditis and altered cerebrospinal fluid (CSF) dynamics, which create the conditions for various pathologies, to appear in different ways in