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Thread: New surgical approach for late complications from spinal cord injury

  1. #21

    Exclamation What's the New in the procedure?

    Hello Dr.Young,


    I’m a T2 - T3 SCI “victim” since Sept. 2000. After a regular “maintenance” MRI in 2005 (previous was in 2000) it came out that I’ve a very big post-traumatic syrinx extending from C7 to T8 level. The MRI which I had a few months ago, showed that there are no changes to the syrinx compared to situation last year.
    Nevertheless I’m really worried and will be very grateful if You answer a few questions that arose after I read this post:
    • The described method requires laminectomy – does it mean that it’s done along the whole part of the spine taken by the syrinx (which in my case is C7-T8) ?
    2. Isn’t the laminectomy cutting the nerves that come from the spine at the level that it’s applied, thus causing further damage to the nerve functions?
    3. How is the dura matter restored after it’s cleaned – what’s the used material, is there a risk of following cancer occurrence at this place?
    4. What’s used to prevent the reoccurrence of the syrinx and scar tissue?
    5. By the way, at the end of the day was the ADCON Gel widely accepted and implemented?

    As far as I remember from your previous posts, you say that the best way to fight the syrinx is to remove it. Not shunting, not emptying but removing it in order to restore the normal CSF circulation.

    6. Finally, what’s the NEW! in the procedure described in this article?


    Thank You very much once again for your answers and your time.

    Have a great week.
    Regards,

  2. #22
    Quote Originally Posted by vl_gyurov
    Hello Dr.Young,


    I’m a T2 - T3 SCI “victim” since Sept. 2000. After a regular “maintenance” MRI in 2005 (previous was in 2000) it came out that I’ve a very big post-traumatic syrinx extending from C7 to T8 level. The MRI which I had a few months ago, showed that there are no changes to the syrinx compared to situation last year.
    Nevertheless I’m really worried and will be very grateful if You answer a few questions that arose after I read this post:
    • The described method requires laminectomy – does it mean that it’s done along the whole part of the spine taken by the syrinx (which in my case is C7-T8) ?
    2. Isn’t the laminectomy cutting the nerves that come from the spine at the level that it’s applied, thus causing further damage to the nerve functions?

    • The extent of the laminectomy depends on where the meningeal adhesions are located. Presumably the syringomyelic cyst is resulting from diversion of cerebrospinal fluid flow to the central canal and the obstruction could be in a relatively small area in the region of the spinal cord. One would only need to operate where the adhesions are, to remove them.
    3. How is the dura matter restored after it’s cleaned – what’s the used material, is there a risk of following cancer occurrence at this place?

    • The dura mater would be incised to expose the spinal cord. The length of dural incusion would depend on where and how much of the spinal cord needs to be exposed. Presumably, this would be only in a limited part of the cord.
    4. What’s used to prevent the reoccurrence of the syrinx and scar tissue?

    • Very good question. This is the fear that many surgeons have. The surgery has to be meticulously done, with care taken not to cause hemorrhage and to remove adhesions with least amount of damage to the tissues. It may be necessary to place a dural patch to give sufficient room for the spinal cord. The material that can be used for such a patch is contorversial. It is preferable to use a natural material but while cadaver human dura is available, there is also a slight risk that such grafts may result in the transmission of disease such as the Creutzfeldt-Jacob disease. Synthetic grafts have been used but most of these grafts are not particularly good. We have been experimenting with new methods of synthetic materials in the laboratory and hope to publish our results soon with a new "sandwich" method of repairing dura with biodegradable synthetic materials that avoid some of the problems that existing materials have.
    5. By the way, at the end of the day was the ADCON Gel widely accepted and implemented?

    • Adcon gel is not available at the present. It effectively stops adhesive scarring but it also stops the dura from healing.
    As far as I remember from your previous posts, you say that the best way to fight the syrinx is to remove it. Not shunting, not emptying but removing it in order to restore the normal CSF circulation.

    • There is not way of "removing" the cyst. One removes the adhesions that cause the cerebrospinal fluid blockade and restore CSF flow.
    6. Finally, what’s the NEW! in the procedure described in this article?

    • The author of the article is looking at this article and perhaps he can best answer this question. From reading the paper, I think that he is not using any specific new techniques but good old-fashioned surgery to remove adhesions and anything that may be compressing the spinal cord, including the posterior longitudinal ligament. I think that he has been more systematic and aggressive in his removal of adhesions than other surgeons. He is reporting quite impressive improvements in the patients and I think that I am impressed by the results that he is getting.
    Thank You very much once again for your answers and your time.

    Have a great week.
    Regards,

    I have long been a proponent of removing adhesive scarring of the meningues to restore cerebrospinal fluid flow after spinal cord injury. In my opinion, the presence of syringomylic cyst is prma facie evidence of cerebrospinal fluid blockade somewhere. The difficult, as you have pointed out, is identifying where the adhesions are, doing the surgery to get to the adhesions and removing them without causing further inflammation and adhesions. The dura grafting is important for avoiding further adhesions in the future. There is controversy concerning the type of dural graft material that can and should be used.

    Wise.

  3. #23
    there is the person who had this surgery?

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