Direct fluoroscopic drainage of symptomatic post-traumatic syringomyelia. A case report and review of the literature.

Summary: First described in 1928, percutaneous aspiration of syringomyelia is infrequently performed to aid in diagnosis and surgical management. We describe a case of post traumatic syringomyelia successfully treated with direct fluoroscopic drainage with substantial resolution of syrinx-related neurologic symptoms. The patient is a 36-year-old man involved in a motorcycle accident who sustained multiple vertebral fractures resulting in dense paraplegia below T4, ultimately treated with multilevel laminectomy and pedicle screw fixation. The patient began to experience phantom leg paresthesias and muscle spasm felt to be related to an extensive spinal cord syrinx extending to the conus. Syrinx drainage was accomplished fluoroscopically at the level of the conus by percuntaneous needle drainage after cord localization with intrathecal myelographic contrast. Clear spinal fluid was drained from the syrinx cavity without complication. Immediately during and after drainage, the patient recognized a decrease in phantom pelvic and lower extremity paresthesias with significantly reduced spasticity. Syrinx collapse was documented with post-drainage CT imaging. Sustained relief of paresthesias and muscle spasms was achieved with gradual syrinx and symptom return requiring subsequent drainages performed at nine, 22 and 37 months following the initial drainage. In addition to confirming the symptomatic nature of syringomyelia in those with atypical symptoms, fluoroscopically guided drainage of syrinx can in select instances provide sustained relief. This modality may have additional advantages including serving as an adjunctive maneuver to improve operative access to the subarachnoid space by collapsing the cord, and serving as a temporizing measure for those patients who are poor surgical candidates. Maneuvers such as fluoroscopic table angulation provide an additional benefit in both the localization and drainage of syringomyelia and thus may be preferred over other minimally invasive procedures such as CT-guided drainage.