Role of Preoperative Albumin Quotient in Surgical Planning for Post-Traumatic Syringomyelia: A Comparative Cohort Study.

OBJECTIVE: Surgical procedures for patients with post-traumatic syringomyelia (PTS) remain controversial. Until now, there have been no effective quantitative evaluation methods to assist in selecting appropriate surgical plans before surgery.

METHODS: We consecutively enrolled PTS patients (arachnoid lysis group, n=42; shunting group, n=14) from 2003 to 2023. Additionally, 19 intrathecal anesthesia patients were included in the control group. All patients with PTS underwent physical and neurological examinations and spinal MRI preoperatively, 3-12 months postoperatively and during the last follow-up. Preoperative lumbar puncture was performed and BSCB disruption was detected by albumin quotient (CSF/serum, QAlb).

RESULTS: The ages (P=0.324) and sex (P=0.065) of the PTS and CTRL groups did not differ significantly. There were also no significant differences in age (P=0.216), routine blood data and prognosis (P=0.399) between the arachnoid lysis and shunting groups. But the QAlb level of PTS patients was significantly higher than that of the control group (P<0.001), and the shunting group had a significantly higher QAlb (P<0.001) than the arachnoid lysis group. A high preoperative QAlb (OR=1.091, 95% CI 1.004-1.187, P=0.041) was identified as the predictive factor for the shunting procedure, with the ROC curve showing 100% specificity and 80.95% sensitivity for patients with a QAlb > 12.67.

CONCLUSION: Preoperative QAlb is a significant predictive factor for the types of surgery. For PTS patients with a QAlb >12.67, shunting is an appropriate surgical option.