Surgery for the posttraumatic cases has given only slightly more favorable results. With incomplete myelopathy, syringotomy relieved the pain in all 10 patients of Shannon and associates. Where they found the myelopathy to be complete, the cord was transected and the upper stump excised. Sgouros and Williams (1996) studied 57 such patients and recommend decompressive laminectomy and reconstruction of the subarachnoid space as the most effective of the several procedures used in the management of traumatic cavities. An extensive review of surgical approaches to syringomyelia can be found in the article by Brodbelt and Stoodley, who tentatively recommend lysis of arachnoidal adhesions as preferable to shunting or filleting of the cord, but acknowledge that the current state of treatment is unsatisfactory.
The infrequent case of symptomatic purely hydromyelia may benefit from ventriculoperitoneal shunts of hydrocephalus, and a few excellent results are reported. This procedure has also been attempted in type I developmental cases, with unimpressive results unless there is an associated hydrocephalus. Draining the central canal by amputation of the tip of the sacral cord has been unsuccessful and can be harmful. Most patients with hydromyelia do not require treatment.
It is always well to remind oneself that of the more than 30 diseases of the spinal cord, effective means of treatment are available for many of the common ones: spondylosis, extramedullary spinal cord tumors, epidural abscess, hematoma and granuloma (tuberculous, fungal, sarcoidosis), myelitis, syringomyelia, and subacute combined degeneration and other forms of nutritional myelopathy. Many of the inflammatory myelopathies respond well to immune-modulating measures. The physician’s major responsibility is to determine whether the patient has one of these treatable diseases.
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