Posttraumatic syringomyelia

Post-traumatic syringomyelia is a clinical syndrome of delayed progressive myelopathy often corresponding to spinal segments distant from the level of original injury. Harvey Cushing described a syringomyelic syndrome in a patient with cervical gunshot wound. He viewed hematomyelia as the pathologic substrate of both – acute and delayed post-traumatic syringomyelia. The exact incidence is unknown, since the manifestations occur in few patients following spinal cord trauma, and there is a paucity of well-studied autopsy cases of posttraumatic spinal cord cavitation. Wagner & Stolper in 1898 provided the first autopsy description in the postmortem study of a patient with fractures of fifth thoracic and first lumbar vertebrae. They described extensive cavitation of the cord, both rostral and caudal to an area of contusion, which was in close proximity to an area of leptomeningeal thickening, lined by glial cells, and filled with turbid gray fluid. Holmes described cylindrical cavities adjoining the injured segment, extending four or five segments cephalad or caudad. The incidence of spinal cord injury in the developed countries varies between 11.5 and 53.4 cases per million population. In the United States, the incidence is between 721 to 906 per million population. Nearly 21% to 28% of these patients will have syrinx if investigated between one to 30 years after injury. Symptomatic syringomyelia is however seen in only 1% to 9% of the spinal injury