1Department of Neurosurgery, French National Center for Chiari and Syringomyelia (C-MAVEM), Bicêtre Hospital, AP-HP, Paris-Saclay University, Paris; and.
2Medical School, Paris-Saclay University, Le Kremlin-Bicêtre, Paris, France.
J Neurosurg Spine. 2021 Feb 5;34(4):673-679. doi: 10.3171/2020.8.SPINE20928. Print 2021 Apr 1.
Surgical treatment for nonforaminal syringomyelia related to spinal arachnoiditis is still controversial. The authors sought to assess respective outcomes and rates of reintervention for shunting and spinal cord untethering (arachnolysis) in spinal arachnoiditis with syringomyelia.
This retrospective cohort study was conducted at a single reference center for syringomyelia. Patients undergoing arachnolysis and/or shunting interventions for nonforaminal syringomyelia were screened.
The study included 75 patients undergoing 130 interventions. Arachnolysis without shunting was performed in 48 patients, while 27 patients underwent shunting. The mean follow-up between the first surgery and the last outpatient visit was 65.0 months (range 12-379 months, median 53 months). At the last follow-up, the modified McCormick score was improved or stabilized in 83.4% of patients after arachnolysis versus 66.7% after shunting. Thirty-one (41.3%) patients underwent reintervention during follow-up, with a mean delay of 33.2 months. The rate of reintervention was 29.2% in the arachnolysis group versus 63.0% in the shunting group (chi-square = 8.1, p = 0.007). However, this difference was largely driven by the extension of the arachnoiditis: in patients with focal arachnoiditis (≤ 2 spinal segments), the reintervention rate was 21.6% for arachnolysis versus 57.1% for shunting; in patients with extensive arachnoiditis, it was 54.5% versus 65.0%, respectively. Survival analysis assessing the time to the first reintervention demonstrated a better outcome in both the arachnolysis (p = 0.03) and the focal arachnoiditis (p = 0.04) groups.
Arachnolysis led to fewer reinterventions than shunting in patients with nonforaminal syringomyelia. There was a high risk of reintervention for patients with extensive arachnopathies, irrespective of the surgical technique.
针对与脊髓蛛网膜炎相关的非孔型脊髓空洞症的手术治疗仍存在争议。作者旨在评估蛛网膜松解术和脊髓松解术（蛛网膜切开术）治疗脊髓蛛网膜炎伴脊髓空洞症的各自结果和再干预率。
本回顾性队列研究在一家脊髓空洞症的参考中心进行。筛选接受非孔型脊髓空洞症蛛网膜松解术和/或分流术干预的患者。
本研究纳入了 75 例患者的 130 次干预。48 例患者行蛛网膜松解术而不进行分流，27 例患者进行分流。首次手术至最后一次门诊随访的平均时间为 65.0 个月（范围 12-379 个月，中位数 53 个月）。末次随访时，与分流术后相比，蛛网膜松解术后改良 McCormick 评分改善或稳定的患者比例为 83.4%（48 例中的 41 例），为 66.7%（27 例中的 17 例）。31 例（41.3%）患者在随访期间接受了再次干预，平均延迟时间为 33.2 个月。蛛网膜松解组的再干预率为 29.2%，分流组为 63.0%（卡方=8.1，p=0.007）。然而，这种差异主要是由蛛网膜炎的扩展驱动的：在局限型蛛网膜炎（≤2 个脊髓节段）患者中，蛛网膜松解组的再干预率为 21.6%，分流组为 57.1%；在广泛型蛛网膜炎患者中，分别为 54.5%和 65.0%。评估首次再干预时间的生存分析显示，蛛网膜松解术（p=0.03）和局限型蛛网膜炎（p=0.04）组的结果更好。
与分流术相比，非孔型脊髓空洞症患者行蛛网膜松解术的再干预率较低。无论手术技术如何，广泛型蛛网膜炎患者再干预的风险均较高。
