~**~ Omentum Transposition ~**~

Treatment of Refractory Progressive Post-traumatic
Cystic Myelopathy with a New Technique: Myelocyst - Omental Graft

Scott P. Falci, M.D., Paul Zweibel, M.D.
Craig Hospital; Craig Center for Spinal Cord Research, Englewood, CO.

Editor's Note: This synopsis was received December, 1998.
There was no reference to the date of surgery.
This synopsis is being posted to illustrate the effectiveness
of Omental Transposition in reducing or eliminating cysts and fluids.

Progressive post-traumatic cystic myelopathy is treated with various shunting techniques and spinal cord untethering. In some cases the injury is so severe that untethering cannot be performed and the cyst remains refractory to shunting procedures. We describe the first case of spinal cord cyst obliteration in a aptient using his own omentum maintained on it's vascular pedicle.

The patient is a 38 year-old C5 quadriplegic male with ascending cystic myelopathy into the brainstem. Multiple shunting procedures failed to stop the progression of the cyst. After his third shunting in one years time, the patient presented with respiratory compromise and weakness of accessory muscles of respiration. Baseline FUC was 440 cc sitting, 800 cc supine. A myelocyst-omental graft was performed, filling the cyst cavity with the patients omentum maintained on its vascular pedicle. At one year followup, the patient's cyst has been obliterated with omental graft, his FUC is 180% of baseline, his accessory muscles of respiration have increased in strength, he has recruited new muscle groups, and he is living independently at home. He, in fact, progressed to a neurological state which existed two years prior to the surgery.

It is felt that omentum incorporates into cord tissue, providing additional vascularity and cellular matrix, thereby halting cystic myelopathy and allowing for some recover.