Radiologic evaluation of spinal cord fissures.

The clinical course and radiographic studies were reviewed of eight patients with posttraumatic spinal cord fissures (rents in the spinal cord communicating with the subarachnoid space). Five patients had spinal cord fissures associated with symptomatic intramedullary cysts that required shunting to alleviate progressive neurologic deficits and intractable pain. Their metrizamide myelograms showed contrast medium passing immediately from the subarachnoid sac into the spinal cord and their immediate metrizamide CT scans delineated the entire extent of the secondary cord cysts. Intraoperative sonography confirmed the presence of the cord fissures with sizeable cysts, detected adhesions, and guided myelotomies and the subsequent shunting and collapse of the cysts. Since neurologic improvement followed the shunting procedures in all five patients treated for progressive symptoms, it was concluded that early radiologic evaluation of posttraumatic spinal cord fissures with symptomatic cord cysts is crucial in the clinical management of these patients.