Posttraumatic syringomyelia is a recognized complication of spinal cord injury, often associated with progressive neurologic decline and surgical management. Its natural history remains incompletely understood, and spontaneous resolution is rare. We performed a literature review identifying six previously reported cases of spontaneous radiologic resolution of posttraumatic syringomyelia and report a 69-year-old patient with posttraumatic cervicothoracic syringomyelia showing a dynamic course characterized by initial mild enlargement followed by spontaneous radiologic resolution over 13 years of follow-up. Initial MR imaging in 2013 demonstrated a focal expansile syrinx at C7–T1 without enhancement, cerebrospinal fluid flow obstruction, or Chiari malformation. At presentation, the patient reported occipital headaches, dizziness, and subjective upper extremity weakness. Serial MR imaging demonstrated mild interval enlargement in 2019, followed by progressive decrease in 2022 and 2024, and near-complete resolution in 2026, with a residual slit-like cavity and focal cord thinning. Neurologic examinations remained normal throughout follow-up, and symptoms resolved. This case demonstrates a dynamic course of posttraumatic syringomyelia with spontaneous radiologic resolution and clinical stability in the absence of surgical intervention. These findings suggest that a subset of patients may follow a benign or reversible course, supporting close clinical and imaging follow-up in selected cases.
Prospective case series with body mass index (BMI)-matched case-controls. To compare resting and postprandial inflammasome biomarkers and metabolic measurements in people with and without chronic spinal cord injury (SCI). A tertiary academic rehabilitation center in an urban, metropolitan setting in the southeastern United States. Blood samples were collected from 5 individuals with chronic SCI and 5 BMI-matched controls without chronic SCI at baseline and at 80 and 400 min following the consumption of a 600-kcal liquid meal comprised of 35% fat, 50% carbohydrate, and 15% protein. Inflammasome biomarkers included apoptosis-associated speck-like protein containing a caspase recruitment domain (ASC), interleukin-18 (IL-18), caspase-1 (CASP-1), and triggering receptor expressed on myeloid cells-2 (TREM-2). Metabolic biomarkers included glucose, insulin, triglyceride (TG), non-esterified fatty acid (NEFA), and glycerol. Individuals with chronic SCI showed higher mean baseline concentrations of all inflammatory markers. There were greater mean postprandial decreases of ASC and CASP-1, with values remaining below baseline at 400 min. IL-18 remained near baseline. TREM-2 declined modestly in both groups. There were relative differences in glycemic and lipemic postprandial responses between groups at 80 min. In this case series, individuals with chronic SCI exhibited higher mean baseline inflammasome biomarker levels and different postprandial trajectories compared to controls. These preliminary hypothesis-generating observations warrant adequately powered studies to clarify the role of inflammasome-related mechanisms in inflammatory and metabolic dysregulation of chronic SCI.
Repeated measures comparative study. Compare acute effects of 4 treatment conditions: (i) abdominal binder (Binder), (ii) abdominal functional electrical stimulation (AFES), (iii) AFES and binder (AFES-Binder), and (iv) no intervention (Control), on signs of orthostatic hypotension (OH) and blood pressure (BP) maintenance in individuals with acute and subacute spinal cord injury (SCI). Spinal injury inpatient ward. Eleven participants with SCI (C3-T5) with at least one sign or symptom of OH underwent a passive sit-up test on 4 days with the 4 treatment conditions. Non-invasive continuous recordings of systolic BP, diastolic BP and calculated mean arterial pressure (MAP) were measured during 4 periods: (1) supine without treatment (5 min); (2) supine with treatment (5 min); (3) upright with treatment (up to 15 min); and (4) supine post-treatment (10 min). Largest drops in BP still resulted in OH in all conditions (p < 0.001), with the largest instantaneous change in MAP in the Binder condition (−41 mmHg [95% CI, −47 to −34]). AFES-Binder condition maintained mean upright MAP relative to supine (−1 mmHg [95% CI, −5 to 2], p = 0.291). Mean upright MAP decreased in all other conditions [Control: (−4 mmHg [95% CI, −7 to −1], p = 0.002); Binder: (−7 mmHg [−10 to −4], p < 0.001); AFES: (−6 mmHg [95% CI, −9 to −2], p < 0.001)]. Mean upright MAP was highest in the AFES-Binder condition. No single treatment condition prevented OH completely. While AFES with abdominal binder does not eliminate OH, it shows potential to mitigate BP instability during postural transitions in acute and subacute SCI.
Autonomic dysreflexia (AD) is a potentially fatal syndrome in people with spinal cord injury (SCI) marked by episodic hypertension with flushing, diaphoresis, and bradycardia. Common etiologies include bladder distension and bowel impaction. Compressive neuropathies lack attention as a potential precipitant of AD. This report describes an individual with cervical SCI and with recurrent AD treated with ulnar nerve decompression surgery. A 74-year-old woman with a remote history of C6 SCI (American Spinal Injury Association Impairment Scale Grade B) presented to clinic with recurrent episodes of AD that had been refractory to standard treatment measures. History and clinical examination were suggestive of ulnar nerve compressive neuropathy at the elbow - cubital tunnel syndrome. The diagnosis was confirmed with electrodiagnostic studies and neuromuscular ultrasound. Treatment with surgery successfully resolved her episodes of AD. This case identifies compressive neuropathy as a treatable cause of AD in individuals with cervical SCI. When more common etiologies of AD are excluded, clinicians should consider compressive peripheral neuropathies as potential causes of AD. Surgical decompression may alleviate symptoms of AD in select cases. Further research should investigate the prevalence and optimal management of compressive neuropathy in people with SCI.
Observational, descriptive and retrospective study. This article’s objective is to analyze the epidemiological characteristics, anatomical distribution, and functional status of persons with vertebral tumors treated at a tertiary care center in an emerging country between 2019 and 2023. January 1, 2019, to December 31, 2023 (5 years), at the Department of Peripheric Nerve, Traumatology and Orthopedic Hospital “Dr. Victorio de la Fuente Narváez”, Mexico City, Mexico. It was conducted an observational descriptive and retrospective study analyzing 358 persons with confirmed vertebral tumors. All cases were evaluated using the ASIA/ISCoS International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) worksheet at admission. Histopathological diagnosis, anatomical location, healthcare level at diagnosis, and ASIA Impairment Scale (AIS) were analyzed using descriptive statistics. Of the 358 cases analyzed, 88% were malignant lesions, with metastatic tumors—especially from breast, prostate, and kidney—being the most common. The thoracic spine was the most frequently affected region (47.2%). AIS D (moderate motor deficit) was the most prevalent classification (46.6%). Emergency department diagnoses increased over the study period, from 24.4% in 2019 to 57% in 2023, while referrals from primary and secondary care declined. Malignant tumors predominated in persons aged 41–80, while benign tumors were more frequent in younger persons. Most vertebral tumors were diagnosed at advanced stages and in emergency settings, suggesting a need to improve early detection and referral systems. Enhanced training and integration across healthcare levels are essential to optimize outcomes in individuals with vertebral tumors in resource-limited settings. No funding sources influenced the design, execution, or interpretation of the research presented in this article.
