Abstract Details

Title Clinical and Radiologic Spectrum and Outcomes of Myelopathy Associated with Spinal Cord Displacement: A Single-center Cohort Study

Topic General Neurology

Presentation(s) P9 - Poster Session 9 (5:00 PM-6:00 PM)

Poster/Presentation
Number 7-004

Objective To characterize clinical and radiologic features of intrathecal spinal cord displacement and to develop a diagnostic algorithm. To evaluate outcomes, including disability progression and reoperation rates, in this population.

Background

Myelopathies associated with intrathecal spinal cord displacement are uncommon and frequently misdiagnosed. The most common etiologies are spinal cord herniation (SCH), arachnoid web (AW), and arachnoid cyst (AC). Comparative analyses stratified by etiology and treatment (surgical or non-surgical) remain limited.

Design/Methods

Retrospective cohort study of adults (≥18 years) evaluated at Mayo Clinic (1996–2017) for myelopathy with imaging evidence of intrathecal spinal cord displacement. Exposures were classified by diagnosis (SCH, AC, or AW) and by surgical intervention, and outcomes included diagnosis confirmed surgically or by MRI features, disability status (Expanded Disability Status Scale [EDSS], ambulatory function), and postoperative worsening.

Results Fifty-nine patients were included: 30 AC (50.8%), 15 SCH (25.4%), and 14 AW (23.7%). Logistic regression identified imaging features with high diagnostic accuracy: short C-shaped displacement of the cord, extradural fluid and preserved CSF pulsation in SCH (AUC 0.942); smooth, long cord displacement with disrupted pulsation and CSF plane between dura and the cord in AC (AUC 0.973); and sharp “scalpel-like” deformity of the cord with preserved pulsation in AW (AUC 0.876). Thirty-six patients (61%) underwent surgery. SCH had worse disability nadir (median EDSS 4.0) than AC (2.5) or AW (1.5; p=0.024), and worse long-term recovery (p=0.021). Superficial siderosis was found in 4/9 SCH patients with brain imaging (44%). Postsurgical worsening risk was higher in SCH (HR 3.2; 95% CI 1.2–8.7), independent of age, EDSS, surgical delay, or intramedullary T2 lesions.

Conclusions

Despite clinical overlap, radiology robustly discriminates AW, AC, and SCH. SCH is associated with higher disability and worse outcomes than AC or AW at surgery and follow-up, likely reflecting diagnostic delay, worse cord pathology and surgical complexity.

Authors/Disclosures
Eoin P. Flanagan, MBBCh, FAAN (Mayo Clinic) PRESENTER	The institution of Dr. Flanagan has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Flanagan has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Pharmacy times. The institution of Dr. Flanagan has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for UCB. The institution of Dr. Flanagan has received research support from UCB. The institution of Dr. Flanagan has received research support from Roche. The institution of Dr. Flanagan has received research support from UCB. The institution of Dr. Flanagan has received research support from Merck. The institution of Dr. Flanagan has received research support from Roche. Dr. Flanagan has received publishing royalties from a publication relating to health care. Dr. Flanagan has received publishing royalties from a publication relating to health care. Dr. Flanagan has a non-compensated relationship as a Member of medical Advisory Board with The MOG Project that is relevant to AAN interests or activities. Dr. Flanagan has a non-compensated relationship as a Editorial board member with Journal of The Neurologic Sciences that is relevant to AAN interests or activities. Dr. Flanagan has a non-compensated relationship as a Editorial board member with Neuroimmunology Reports that is relevant to AAN interests or activities. Dr. Flanagan has a non-compensated relationship as a Editorial Board Member with Neurology, Neuroimmunology Neuroinflammation (N2) Journal that is relevant to AAN interests or activities. Dr. Flanagan has a non-compensated relationship as a Editorial Board Member with Neurology that is relevant to AAN interests or activities.
Andreu Vilaseca-Jolonch, MD	Dr. Vilaseca-Jolonch has received research support from Fundación Martín Escudero.
Timothy J. Kaufmann, MD	Dr. Kaufmann has stock in SpineThera.
William Krauss, MD	Dr. Krauss has nothing to disclose.
Brian G. Weinshenker, MD, FAAN (University of Virginia Health System)	Dr. Weinshenker has received personal compensation in the range of $500-$4,999 for serving as a Consultant for CANbridge Pharmaceuticals. Dr. Weinshenker has received personal compensation in the range of $0-$499 for serving as a Consultant for CALIBR. Dr. Weinshenker has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Horizon. Dr. Weinshenker has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Weinshenker has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche Group (Chugai, Genentech, Roche). Dr. Weinshenker has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for UCB Pharmaceuticals. Dr. Weinshenker has received research support from Guthy Jackson Charitable Foundation. Dr. Weinshenker has received intellectual property interests from a discovery or technology relating to health care.

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