Neurosurgery notes/Post traumatic syringomyelia

Post traumatic syringomyelia

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Syringomyelia
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Last edited time
Jul 25, 2026 12:14 PM GMT+0

Numbers

  • Fewer than 10% of syringomyelia cases are of this type
  • Incidence of posttraumatic syringomyelia (951 pts follow up 11 yrs)
    • Type of injury
    No./risk
    Incidence
    All spinal cord injuries
    30/951
    3.2%
    Complete quadriplegia
    14/177
    7.9%
    Incomplete quadriplegia
    4/181
    4.5%
    Complete paraplegia
    4/282
    1.7%
    Incomplete paraplegia
    4/181
    2.2%
  • Fewer cases of syrinx following cervical injuries than following thoracic injuries
    • Might be artefactual as low lesions will allow more deficits as it ascends
  • Latency following spinal cord injury
    • Latency to symptoms:
      • 3 mos to 34 yrs (mean 9 yrs)
      • Earlier in complete cord lesions than incomplete: mean 7.5 vs. 9.9 yrs
    • Latency to diagnosis:
      • Up to 12 yrs (mean 2.8 yrs) after onset of new symptoms
 
  • Syringomyelia due to spinal cord injury
    • Fewer than 10% of syringomyelia cases are of this type
    • Mechanisms of injury include
      1. Spinal trauma
      2. Radiation necrosis
      3. Hemorrhage from aneurysm rupture or arteriovenous malformation or in a tumor bed
      4. Infection (spinal abscess, human immunodeficiency virus, transverse myelitis)
      5. Cavitation following ischemic injury or degenerative disease

Aetiology

  • May follow significant spinal trauma (with or without clinical spinal cord injury).
    • Penetrating injury or
    • Non-penetrating “violent” trauma to the spinal cord
  • Does not include post-spinal anaesthesia or following thoracic disc herniation

Clinical features

  • The late appearance of upper extremity symptoms in a paraplegic patient should raise a high index of suspicion of posttraumatic syringomyelia.
  • Hyperhidrosis may be the only feature of descending syringomyelia in patients with complete cord lesions.
    • Presentation (in 30 SCI patients with syrinx)
      • Symptom
      Initial
      At time of diagnosis
      Painᵃ
      57%
      70%
      Numbness
      27%
      40%
      Increased motor deficit
      23%
      40%
      Increased spasticity
      10%
      23%
      Increased sweating (hyperhidrosis)
      3%
      13%
      Autonomic dysreflexia
      3%
      3%
      No symptoms
      7%
      7%
      • ᵃpain is often quite severe, and unrelieved with analgesics
      Signs
      Frequency
      Ascending sensory level
      93%
      Depressed tendon reflexes
      77%
      Increased motor deficits
      40%

Imaging

  • One end of the syrinx is at the site of spinal column fracture or abnormal angulation

Management

  • Conservative
    • 31% remained stable
    • 68% progressed over yrs (longer F/U in latter).
  • Surgical
    • No benefit in operating on a patient with a small syrinx.
    • Options
      • Same as in communicating syringomyelia, with the following differences:
        • Cord transection (cordectomy)66: an option in complete injuries only
        • Plugging the obex (where 4th becomes central canal) is probably not indicated (controversial in congenital syrinx)

Outcome

  • In 9 patients treated with syringosubarachnoid shunt
    • Pain relieved
    9
    Motor recovery
    5/8
    Tendon reflex improved
    1/10
  • Post-op complications in 9 patients included
    • Incomplete lesion became complete
    1
    Sensorimotor deterioration
    1
    Transient pain
    3
  • Most results are good for radicular symptoms, with dubious efficacy for autonomic symptoms or spasticity.