Spinal Cord (2018) 56:873–882 https://doi.org/10.1038/s41393-018-0094-y ARTICLE Neurosurgical untethering with or without syrinx drainage results in high patient satisfaction and favorable clinical outcome in post- traumatic myelopathy patients Ulrika Holmström 1 ● Parmenion P. Tsitsopoulos 1,2 ● Hjalmar Flygt 1 ● Anders Holtz 1 ● Niklas Marklund 1,3 Received: 20 December 2017 / Revised: 2 March 2018 / Accepted: 6 March 2018 / Published online: 27 March 2018 © International Spinal Cord Society 2018 Abstract Study design Retrospective data collection and patient-reported outcome measures. Objectives To investigate surgical outcome, complications, and patient satisfaction in patients with chronic SCI and symptomatic post-traumatic progressive myelopathy (PPM) who underwent neurosurgical untethering and/or spinal cord cyst drainage with the aim of preventing further neurological deterioration. Setting Single-center study at an academic neurosurgery department. Methods All SCI patients who underwent neurosurgery between 1996 and 2013 were retrospectively included. All medical charts and the treating surgeon’s operative reports were reviewed to identify surgical indications, surgical technique, and post-operative complications. A questionnaire and an EQ-5D-instrument were used to assess patient's self-described health status and satisfaction at long-term follow-up. Results Fifty-two patients (43 men, 9 women) were identified, of whom five were dead and one was lost to follow-up. Main indications for surgery were pain (54%), motor (37%), or sensory (8%) impairment, and spasticity (2.0%). Overall com- plications were rare (8%). At follow-up, the subjectively perceived outcome was improved in 24 and remained unchanged in 21 patients. Thus, the surgical aim was met in 87% of patients. Of the 46 eligible patients, 38 responded to the questionnaire of whom 65% were satisfied with the surgical results. Patients with cervical lesions were more satisfied with the surgical treatment than patients with thoracic/thoracolumbar lesions (p = 0.05). Conclusions Neurosurgical untethering and/or cyst drainage in chronic SCI patients and PPM resulted in a high degree of patient satisfaction, particularly in cervical SCI patients with minimal complications. Introduction At time of spinal trauma, the spinal cord may be injured leading to various degrees of neurological dysfunction at and below the affected level [1, 2]. A minor proportion of patients, most commonly those with incomplete SCI, show a degree of neurological improvement during the first period post injury [3]. However, most disabilities seen in SCI patients are chronic and do not recover significantly with time [4, 5]. After a period ranging from few months up to several decades following the initial injury, a subset of SCI patients may present with gradual worsening of the neurological deficits or may develop new symptoms resulting from progressive post-traumatic myelopathy (PPM). The clinical entity of PPM includes the classical symptoms of pain, disturbance of motor and sensory function, impairment of temperature sensation, hyperhidrosis, autonomic dysfunc- tion, increased spasticity, Horner’s syndrome, and impaired bladder and bowel control [4, 6–12]. The relationship between spinal arachnoid scarring and syringomyelia was recognized as early as 1938 [13]. Scar formation and spinal cord tethering are considered causative Deseased: Anders Holtz. * Niklas Marklund niklas.marklund@neuro.uu.se 1 Department of Neuroscience and Neurosurgery, Uppsala University, Uppsala, Sweden 2 Hippokratio General Hospital, Aristotle University, Thessaloniki, Greece 3 Department of Clinical Sciences Lund, Neurosurgery, Lund University, Skåne University Hospital, Lund, Sweden 1234567890();,: 1234567890();,: