Zhang Can, Yuan Chenghua, Wang Jiachen, Wu Hao, Chen Zan, Jian Fengzeng, Guan Jian
Department of Neurosurgery, The First Hospital of Hebei Medical University, Shijiazhuang 050000, Shijiazhuang, China.
Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
Eur Spine J. 2025 Aug 11. doi: 10.1007/s00586-025-09197-x.
Current surgical options for treating non-traumatic adhesive syringomyelia, particularly in patients with a history of previous spinal canal surgery, lack clear standardization and frequently lead to common complications such as recurrent adhesions, tube disconnections, and neurological injuries related to myelotomy, resulting in the need for multiple revision surgeries. This study aims to introduce a novel, minimally invasive technique of modified subarachnoid-subarachnoid (S - S) bypass procedure for syringomyelia associated with postoperative arachnoid adhesions and to prospectively evaluate its surgical outcomes.
This prospective study included 11 consecutive patients with syringomyelia related to postoperative arachnoid adhesions who underwent modified S-S bypass surgery, with a mean follow-up period of 18.3 months (range: 16-20 months). Neurological function was assessed using standardized grading systems, and changes in syrinx size were evaluated using MRI.
Ten patients demonstrated clinical improvement, while one patient remained stable. Notably, the preoperative and postoperative ASIA motor and sensory scores showed significant improvement (88.45 ± 11.01 vs. 89.64 ± 9.99, p < 0.05; 200.73 ± 15.52 vs. 203.09 ± 15.29, p < 0.001). The mean syrinx tension index postoperatively was significantly lower than the preoperative value (74.28 ± 14.34% vs. 29.87 ± 17.62%, p < 0.0001), and the syrinx length was also significantly reduced (9.46 ± 4.59 vs. 8.00 ± 6.05, p < 0.05).
This study highlights that the modified S-S bypass can be performed without myelotomy or intratubal interaction with CSF circulation, representing not only a safe and effective surgical technique but also a potentially more physiological approach for treating syringomyelia associated with postoperative arachnoid adhesions.
目前治疗非创伤性粘连性脊髓空洞症的手术选择，尤其是有既往椎管手术史的患者，缺乏明确的标准化，且常导致诸如粘连复发、导管断开以及与脊髓切开术相关的神经损伤等常见并发症，从而需要多次翻修手术。本研究旨在介绍一种用于治疗与术后蛛网膜粘连相关的脊髓空洞症的新型微创改良蛛网膜下腔 - 蛛网膜下腔（S - S）分流术，并前瞻性评估其手术效果。
本前瞻性研究纳入了11例因术后蛛网膜粘连导致脊髓空洞症的连续患者，他们接受了改良S - S分流手术，平均随访期为18.3个月（范围：16 - 20个月）。使用标准化分级系统评估神经功能，并通过MRI评估脊髓空洞大小的变化。
10例患者临床症状改善，1例患者病情稳定。值得注意的是，术前和术后美国脊髓损伤协会（ASIA）运动和感觉评分有显著改善（88.45 ± 11.01 vs. 89.64 ± 9.99，p < 0.05；200.73 ± 15.52 vs. 203.09 ± 15.29，p < 0.001）。术后脊髓空洞张力指数的平均值显著低于术前值（74.28 ± 14.34% vs. 29.87 ± 17.62%，p < 0.0001），脊髓空洞长度也显著缩短（9.46 ± 4.59 vs. 8.00 ± 6.05，p < 0.05）。
本研究强调改良S - S分流术无需进行脊髓切开术或与脑脊液循环进行管内交互即可实施，这不仅是一种安全有效的手术技术，也是治疗与术后蛛网膜粘连相关的脊髓空洞症的一种潜在更符合生理的方法。
