• Chenghua Yuan, Pingchuan Xia, Wanru Duan, Jiachen Wang, Jian Guan, Yueqi Du, Can Zhang, Zhenlei Liu, Kai Wang, Zuowei Wang, Xingwen Wang, Hao Wu, Zan Chen, and Fengzeng Jian.
• Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
• Spine. 2024 Mar 15; 49 (6): E62E71E62-E71.

Study DesignCohort study.ObjectiveThe aim of this study was to explore the association between blood-spinal cord barrier (BSCB) markers and other factors associated with an unfavorable outcome among patients with post-traumatic syringomyelia (PTS) who achieved successful intradural adhesion lysis (IAL).Summary Of Background DataOnly approximately half of PTS patients receiving IAL have a favorable outcome.Patients And MethodsForty-six consecutive patients with PTS and 19 controls (CTRL) were enrolled. All PTS patients underwent physical and neurological examinations and spinal magnetic resonance imaging before and 3 to 12 months after IAL. All patients underwent myelography before surgery. BSCB disruption was detected by increased intrathecal and serum concentrations of albumin, immunoglobulin (Ig)G, IgA, and IgM. A multivariable analysis was performed with a logistic regression model to identify factors associated with unfavorable outcomes. Receiver operating characteristic curves were calculated to investigate the diagnostic value of biomarkers.ResultsThe ages and general health of the PTS and CTRL groups did not differ significantly. QAlb, IGAQ, IGGQ, and IGMQ was significantly higher in PTS patients than in controls ( P =<0.001). The degree of intradural adhesion was significantly higher in the unfavorable outcome group than in the favorable outcome group ( P <0.0001). QAlb, immunoglobulin (Ig)AQ, IGGQ, and IGMQ was significantly correlated with clinical status ( R =-0.38, P <0.01; R =-0.47, P =0.03; R =-0.56, P =0.01; R =-0.43, P =0.05, respectively). Higher QAlb before surgery (odds ratio=2.66; 95% CI: 1.134-6.248) was significantly associated with an unfavorable outcome. The receiver operating characteristic curve analysis demonstrated a cutoff for QAlb higher than 10.62 with a specificity of 100% and sensitivity of 96.3%.ConclusionThis study is the first to detect increased permeability and BSCB disruption in PTS patients. QAlb>10.62 was significantly associated with unfavorable clinical outcomes following intradural decompression.Level Of EvidenceLevel III-prognostic.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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