Прогрессирующая посттравматическая сирингомиелия (клинический случай)

Бушков Ф.А., Бжилянский М.А. Прогрессирующая посттравматическая сирингомиелия. Consilium Medicum. 2020; 22 (9): 87–90. DOI: 10.26442/20751753.2020.9.200268

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Bushkov F.A., Bzhylansky M.A. Progressive posttraumatic cystic myelopathy. Consilium Medicum. 2020; 22 (9): 87–90. DOI: 10.26442/20751753.2020.9.200268

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Аннотация

Посттравматическая прогрессирующая сирингомиелия – редкое состояние, возникающее после спинномозговой травмы, приводящее к нарастанию неврологического дефицита и утяжелению инвалидизации. В патогенезе лежит образование одиночной большой кисты, множественных небольших кист или размягчение спинного мозга (миеломаляция). В статье приводится описание клинического случая прогрессирующей восходящей посттравматической сирингомиелии. Обсуждаются вопросы клинической картины, характера течения, особенностей диагностики и результаты лечения данного состояния.

Ключевые слова: спинномозговая травма, прогрессирующая посттравматическая миелопатия, посттравматическая сирингомиелия.

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Posttraumatic progressive cystic myelopathy is a rare condition that occurs after a spinal cord injury, leading to an increase in neurological deficit and aggravation of disability. In the pathogenesis lies the formation of a single large cyst, multiple small cysts or softening of the spinal cord (myelomalacia). The article describes a clinical case of progressive ascending posttraumatic syringomyelia. Questions of the clinical picture, the course of condition, the features of diagnosis and the results of treatment are discussed.

Key words: spinal cord injury, progressive post-traumatic myelopathy, posttraumatic syringomyelia.

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Список литературы

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2. Schurch B, Wichmann W, Rossier AB. Post-traumatic syringomyelia (cystic myelopathy): a prospective study of 449 patients with spinal cord injury. J Neurol Neurosurg Psychiatry 1996; 60 (1): 61–7. DOI: 10.1136/jnnp.60.1.61
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[Dzugaeva S.B, Biryuchkov Yu.V, L'vovich A.I, Semin A.A. Nekotorye anatomicheskie i klinicheskie osobennosti travmaticheskikh povrezhdenii spinnogo mozga. Nevrologiya i psikhiatriya im. S.S. Korsakova. 1983; 5: 670–5 (in Russian).]
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[Zyablov V.I, Lysenko V.V, Rozgonyuk Yu.D. Arkhiv anatomii gistologii i embriologii. 1986; 1: 27–31 (in Russian).]
9. Lee TT, Arias JM, Andrus HL et al. Progressive posttraumatic myelomalacic myelopathy: treatment with untethering and expansive duraplasty. J Neurosurg 1997; 86 (4): 624–8. DOI: 10.3171/jns.1997.86.4.0624
10. Schwartz ED, Falcone SS, Quencer RM et al. Posttraumatic syringomyelia: pathogenesis, imaging and treatment. Am J Radiol 1999; 173: 487–2. DOI: 10.2214/ajr.173.2.10430159.
11. Biani A, El Masri WS. Post-traumatic syringomyelia: a review of the literature. Paraplegia 1984; 32: 723–31.
12. Quencer RM, Green BA, Eismont FJ. Posttraumatic spinal cord cystic: clinical features and characterization with metrizamide computer tomography. Radiology 1983; 146: 415–23.
13. Watson N. Ascending cystic degeneration of the cord after spinal cord injury. Paraplegia 1981; 19: 89–95.
14. Falcone S, Quencer RM, Green BA et al. Progressive posttraumatic myelomalacic myelopathy: imaging and clinical features. Am J Neuroradiol 1994; 15 (4): 747–54.
15. Lee TT, Alameda GJ, Gromelski EB, Green BA. Outcome after surgical treatment of progressive posttraumatic cystic myelopathy. J Neurosurg 2000; 92 (2): 149–54. DOI: 10.3171/spi.2000.92.2.0149
16. Kirshblum SC, Burns SP, Biering-Sorensen F et al. International standards for neurological classification of spinal cord injury (Revised 2011). J Spinal Cord Med 2011; 34 (6): 535–46. DOI: 10.1179/204577211X13207446293695
17. Van De Meent H, Hosman AJF, Hendriks J et al. Severe degeneration of peripheral motor axons after spinal cord Injury: A European Multicenter Study in 345 Patients. Neurorehabilitation and Neural Repair 2010; 24 (7): 657– 65. DOI: 10.1177/1545968310368534
18. Greitz D. Unraveling the riddle of syringomyelia. Neurosurg Rev 2006; 29: 251–63. DOI: 10.1007/s10143-006-0029-5
19. Bertrand G. Chapter 26. Dynamic factors in the evolution of syringomyelia and syringobulbia. Clin Neurosurg 1973; 20: 322–33.
20. Yeo JD, Walsh J, Rutkowski S et al. Mortality Following Spinal Cord Injury Spinal Cord 1998; 36 (5): 329–36. DOI: 10.1038/sj.sc.3100628
21. Soden RJ, Walsh J, Middleton JW et al. Causes of Death After Spinal Cord Injury. Spinal Cord 2000; 38 (10): 604–10. DOI: 10.1038/sj.sc.3101080

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1. Roiser AB, Foo D, Shillito J, Dyro FM. Posttraumatic cervical syringomyeliac: incidence, clinical presentation, electrophysiological studies, syrinx protein and result of conservative and operative treatment. Brain 1985; 108: 439–61.
2. Schurch B, Wichmann W, Rossier AB. Post-traumatic syringomyelia (cystic myelopathy): a prospective study of 449 patients with spinal cord injury. J Neurol Neurosurg Psychiatry 1996; 60 (1): 61–7. DOI: 10.1136/jnnp.60.1.61
3. Amelina O.S. Travmaticheskaya bolezn' spinnogo mozga (patogeneticheskie, diagnosticheskie i mediko-sotsial'nye aspekty). Avtoref. … dis. kand. med. nauk. Moscow, 1992 (in Russian).
4. Brodskaya Z.L. Rentgenodiagnostika i prognozirovanie posttravmaticheskikh sheinykh mielopatii. Voprosy neirokhirurgii im. N.N. Burdenko. 1983; 2: 33–7 (in Russian).
5. Falci SP, Indeck C, Lammertse DP. Posttraumatic spinal cord tethering and syringomyelia: surgical treatment and long-term outcome. J Neurosurg Spine 2009; 11 (4): 445–60. DOI: 10.3171/2009.4.SPINE09333
6. Dzugaeva S.B, Biryuchkov Yu.V, L'vovich A.I, Semin A.A. Nekotorye anatomicheskie i klinicheskie osobennosti travmaticheskikh povrezhdenii spinnogo mozga. Nevrologiya i psikhiatriya im. S.S. Korsakova. 1983; 5: 670–5 (in Russian).
7. Kao CC, Chang LW, Bloodworth JM. The mechanism of spinal cord cavitation following spinal cord transaction, part2: electron microscopic observation. J Neurosurg 1977; 46: 745–6.
8. Zyablov V.I, Lysenko V.V, Rozgonyuk Yu.D. Arkhiv anatomii gistologii i embriologii. 1986; 1: 27–31 (in Russian).
9. Lee TT, Arias JM, Andrus HL et al. Progressive posttraumatic myelomalacic myelopathy: treatment with untethering and expansive duraplasty. J Neurosurg 1997; 86 (4): 624–8. DOI: 10.3171/jns.1997.86.4.0624
10. Schwartz ED, Falcone SS, Quencer RM et al. Posttraumatic syringomyelia: pathogenesis, imaging and treatment. Am J Radiol 1999; 173: 487–2. DOI: 10.2214/ajr.173.2.10430159.
11. Biani A, El Masri WS. Post-traumatic syringomyelia: a review of the literature. Paraplegia 1984; 32: 723–31.
12. Quencer RM, Green BA, Eismont FJ. Posttraumatic spinal cord cystic: clinical features and characterization with metrizamide computer tomography. Radiology 1983; 146: 415–23.
13. Watson N. Ascending cystic degeneration of the cord after spinal cord injury. Paraplegia 1981; 19: 89–95.
14. Falcone S, Quencer RM, Green BA et al. Progressive posttraumatic myelomalacic myelopathy: imaging and clinical features. Am J Neuroradiol 1994; 15 (4): 747–54.
15. Lee TT, Alameda GJ, Gromelski EB, Green BA. Outcome after surgical treatment of progressive posttraumatic cystic myelopathy. J Neurosurg 2000; 92 (2): 149–54. DOI: 10.3171/spi.2000.92.2.0149
16. Kirshblum SC, Burns SP, Biering-Sorensen F et al. International standards for neurological classification of spinal cord injury (Revised 2011). J Spinal Cord Med 2011; 34 (6): 535–46. DOI: 10.1179/204577211X13207446293695
17. Van De Meent H, Hosman AJF, Hendriks J et al. Severe degeneration of peripheral motor axons after spinal cord Injury: A European Multicenter Study in 345 Patients. Neurorehabilitation and Neural Repair 2010; 24 (7): 657– 65. DOI: 10.1177/1545968310368534
18. Greitz D. Unraveling the riddle of syringomyelia. Neurosurg Rev 2006; 29: 251–63. DOI: 10.1007/s10143-006-0029-5
19. Bertrand G. Chapter 26. Dynamic factors in the evolution of syringomyelia and syringobulbia. Clin Neurosurg 1973; 20: 322–33.
20. Yeo JD, Walsh J, Rutkowski S et al. Mortality Following Spinal Cord Injury Spinal Cord 1998; 36 (5): 329–36. DOI: 10.1038/sj.sc.3100628
21. Soden RJ, Walsh J, Middleton JW et al. Causes of Death After Spinal Cord Injury. Spinal Cord 2000; 38 (10): 604–10. DOI: 10.1038/sj.sc.3101080

Авторы

Ф.А. Бушков*, М.А. Бжилянский

АО «Реабилитационный центр “Преодоление”», Москва, Россия
*bushkovfedor@mail.ru

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Fedor A. Bushkov*, Michail A. Bzhylansky

Rehabilitation Center “Overcoming”, Moscow, Russia
*bushkovfedor@mail.ru

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