Syringomyelia

Cordectomy

Cordectomy has been shown to be a useful procedure in the surgical treatment of syringomyelia. It can be used to manage spasticity, pain and improve neurological dysfunction. However, since it is an invasive procedure and irreversible, it is only considered when other options have been exhausted (Gautschi et al. 2011).

Author Year; Country
Research Design
Score
Total Sample Size

 Methods Outcome

Gautschi et al. 2011; Switzerland
Pre-Post
N=17

Population: Median age: 48.3 yr; Gender: males=15, females=2.
Intervention: Patients received a spinal cordectomy.
Outcome Measures: Quality of life using the EuroQol (EQ), Short Form-36 (SF-36).
  1. Overall EQ scale improved from 42 points to 67 points (p=0.006) postoperatively.
  2. The mental health score on the SF-36 improved significantly (p=0.01), whereas physical health score improved from 34.1 to 55.3 post-surgery (p=0.057).
  3. The majority of patients (16/17) reported that they would undergo the operation again.

Ewelt et al. 2010; Switzerland
Pre-Post
N=15

Population: Mean age: 52 yr; Level of severity: AIS: A=7, B=8.
Intervention: Patients received a spinal cordectomy.
Outcome Measures: ASIA motor and sensory function, Visual Analogue Scale (VAS), Adverse events, Spasticity.
  1. ASIA Scores: eight stabilized, four had improved motor and sensory scores, and one reported a progressive deterioration.
  2. Pain: 10 patients stabilized and two improved.
  3. Spasticity: nine patients stabilized, two improved, and four deteriorated.
  4. No complications relating to surgery were reported.

Discussion

Two pre-post studies examined the spinal cordectomy procedure on individuals with syringomyelia post SCI. Ewelt et al. (2010) found that cordectomy resulted in stabilization and improvement of motor and sensory function in 14 out of 15 patients. The study also reported improvement in pain and spasticity following the procedure. No significant adverse events were reported. Gautschi et al. (2010) reported a significant improvement in the quality of life of individuals who underwent the cordectomy procedure and high levels of subjective satisfaction.

Conclusions

There is level 4 evidence (from one pre-post study: Ewelt et al. 2010) that cordectomy improves motor and sensory function post SCI-related syringomyelia.

There is level 4 evidence (from one pre-post study: Gautschi et al. 2010) that cordectomy improves quality of life of individuals post SCI-related syringomyelia.

Cordectomy may improve motor and sensory function post SCI-related syringomyelia.

Cordectomy may improve quality of life post SCI-related syringomyelia.

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