Table_3_Spinal Obstruction-Related vs. Craniocervical Junction-Related Syringomyelia: A Comparative Study.docx

BackgroundNo prior reports have focused on spinal cord injury (SCI) characteristics or inflammation after destruction of the blood–spinal cord barrier by syringomyelia. This study aimed to determine the differences in syringomyelia-related central SCI between craniocervical junction (CCJ) syringomyelia and post-traumatic syringomyelia (PTS) before and after decompression.
MethodsIn all, 106 CCJ, 26 CCJ revision and 15 PTS patients (mean history of symptoms, 71.5 ± 94.3, 88.9 ± 85.5, and 32.3 ± 48.9 months) between 2015 and 2019 were included. The symptom course was analyzed with the American Spinal Injury Association ASIA and Klekamp–Samii scoring systems, and neurological changes were analyzed by the Kaplan–Meier statistics. The mean follow-up was 20.7 ± 6.2, 21.7 ± 8.8, and 34.8 ± 19.4 months.
ResultsThe interval after injury was longer in the PTS group, but the natural history of syringomyelia was shorter (p = 0.0004 and 0.0173, respectively). The initial symptom was usually paraesthesia (p = 0.258), and the other main symptoms were hypoesthesia (p = 0.006) and abnormal muscle strength (p = 0.004), gait (p < 0.0001), and urination (p < 0.0001). SCI associated with PTS was more severe than that associated with the CCJ (p = 0.003). The cavities in the PTS group were primarily located at the thoracolumbar level, while those in the CCJ group were located at the cervical-thoracic segment at the CCJ. The syrinx/cord ratio of the PTS group was more than 75% (p = 0.009), and the intradural adhesions tended to be more severe (p < 0.0001). However, there were no significant differences in long-term clinical efficacy or peripheral blood inflammation markers (PBIMs) except for the red blood cell (RBC) count (p = 0.042).
ConclusionPTS tends to progress faster than CCJ-related syringomyelia. Except for the RBC count, PBIMs showed no value in distinguishing the two forms of syringomyelia. The predictive value of the neutrophil-to-lymphocyte ratio for syringomyelia-related inflammation was negative except in the acute phase.

背景：目前尚无针对脊髓空洞症（syringomyelia）破坏血脊髓屏障（blood–spinal cord barrier）后脊髓损伤（spinal cord injury, SCI）特征及炎症反应的相关报道。本研究旨在明确减压术前及术后，颅颈交界区（craniocervical junction, CCJ）型脊髓空洞症与创伤后脊髓空洞症（post-traumatic syringomyelia, PTS）相关中枢性脊髓损伤的差异。
方法：本研究纳入2015年至2019年间的106例CCJ型脊髓空洞症患者、26例CCJ型脊髓空洞症翻修患者及15例PTS患者，三组患者的症状平均病程分别为71.5±94.3、88.9±85.5及32.3±48.9个月。采用美国脊髓损伤协会（American Spinal Injury Association, ASIA）评分与Klekamp–Samii评分系统分析患者的症状进程，并通过Kaplan–Meier统计法分析神经系统变化情况。三组患者的平均随访时间分别为20.7±6.2、21.7±8.8及34.8±19.4个月。
结果：PTS组患者的伤后间隔时间更长，但脊髓空洞症的自然病程更短（分别对应p=0.0004与p=0.0173）。患者初始症状多为感觉异常（p=0.258），其余主要症状包括感觉减退（p=0.006）、肌力异常（p=0.004）、步态异常（p<0.0001）及排尿功能异常（p<0.0001）。PTS相关脊髓损伤的严重程度高于CCJ型脊髓空洞症相关脊髓损伤（p=0.003）。PTS组的空洞多位于胸腰段，而CCJ组的空洞多位于CCJ区域的颈胸段。PTS组的空洞/脊髓比值超过75%（p=0.009），且硬膜内粘连程度更严重（p<0.0001）。不过，除红细胞（red blood cell, RBC）计数外（p=0.042），两组的长期临床疗效与外周血炎症标志物（peripheral blood inflammation markers, PBIMs）均无显著差异。
结论：PTS型脊髓空洞症的进展速度快于CCJ型脊髓空洞症。除RBC计数外，外周血炎症标志物无法有效区分两种类型的脊髓空洞症。除急性期外，中性粒细胞与淋巴细胞比值对脊髓空洞症相关炎症的预测价值为阴性。