Mis S-S Bypass Versus Adhesion Lysis in PTS

Recently, our team was the first to report in the Journal of Neurosurgery: Spine (JNSSPINE) a minimally invasive subarachnoid-subarachnoid cerebrospinal fluid bypass technique for the treatment of post-traumatic syringomyelia. This novel approach has attracted considerable international attention and achieved favorable clinical outcomes for the treatment of post-traumatic syringomyelia. To establish high-level evidence, participants with posttraumatic Syringomyelia will be randomized to either have A novel minimally invasive Subarachnoid-Subarachnoid (S-S) Bypass or intradural adhesion Lysis. The participant will then return to the neurosurgeon's office at the following time points which are consistent with standard of care practice: 3-6, 12±2months. At these visits, the clinician will complete a physical exam and the participant will report on the prognosis of symptoms and complete questionnaires. A spine MRI will be performed 3-6, 12±2months after the surgery.

The multicenter design, target sample size, assessor masking, eligibility criteria, and outcome hierarchy described in this record were specified in the ethics-approved protocol before enrollment of the first participant. The initial public registry entry did not fully reflect the finalized protocol. The registry record was corrected on 2026-11, before database lock and before any unblinded between-group analysis, to align it with the prospectively approved protocol.

After dissections of the normal arachnoid mater at the cephalic and caudal sites, 2 tubes made of medical grade silicone (internal diameter 1.1 mm, external diameter 2.5 mm; Sophysa Systems Corp.) were inserted into the cephalic and caudal ends of the normal subarachnoid space.

The tubes were only inserted into the normal subarachnoid space, with the remaining portions running subcutaneously.

Procedure: A novel minimally invasive Subarachnoid-Subarachnoid (S-S) Bypass

The dura is opened sharply, exposing the spinal cord. After microsurgical dissection adhesion, the dura is sewn closed with a dural graft.

Procedure: Intradural Adhesion Lysis

After dissections of the normal dura mater at the cranial and caudal sites, a tunneling device (a passer) was used to create a subcutaneous tunnel. Two tubes made of medical grade silicone (internal diameter 1.1 mm, external diameter 2.5 mm; Sophysa Systems Corp.) were inserted into the cranial and caudal ends of the normal subarachnoid space.

Under the surgical microscope, the normal dura was incised bilaterally approximately 3 mm on either side of the midline at the cranial end. The arachnoid was opened, with the proximal ends of the drainage tubes inserted approximately 5 cm into the normal subarachnoid space, with the remaining portions running subcutaneously. No loosening operations were performed at the site of injury. The incisions were sutured layer by layer

Intradural spinal cord Adhesion Lysis

Plazo: 3-6, 12±2 months

Number of patients who experienced improvement in clinical or neurological symptoms-such as; sensory dysfunction (numbness, paresthesia, or sensory loss), neuropathic pain, motor weakness, gait impairment, bowel and bladder dysfunction, and spasticity.

Plazo: 3-6, 12±2 months

defined as change in length, maximal cross-sectional diameter, or both.

Plazo: 3-6, 12±2 months

for evaluating the spinal cord function, Each item is scored on a scale from 0 to 5, with 5 representing the best possible functional status.

Plazo: 3-6, 12±2 months

Motor function， sensory， bladder function；for evaluating the spinal cord function；0-17， higher scores mean a better outcome

Plazo: 3-6, 12±2 months

for evaluating the spinal cord function, for evaluating the spinal cord function；0-18， higher scores mean a worse outcome

Plazo: 3-6, 12±2 months

various complication, such as fever, csf fistula

Plazo: 3-6, 12±2 months

American Spinal Injury Association(ASIA) Score for evaluating the spinal cord function， degree of the spinal cord function, motor1-100, sensory 1-224, higher scores mean a better outcome

Plazo: 3-6, 12±2 months

VAS Score for evaluating the degree of the pain, VAS 0-10, higher scores mean a worse outcome

A Novel Minimally Invasive Subarachnoid-Subarachnoid (S-S) Bypass Versus Adhesion Lysis in Post-traumatic Syringomyelia