Long-term result of the Echols procedure for treating syringomyelia

Abstract

In 1974, a 9-year-old girl with syringomyelia and scoliosis was treated using the Echols procedure, a surgical technique that makes use of a metal stent to maintain drainage of fluid from the syrinx into the subarachnoid space. The patient presented to the authors' institution 34 years later with a history of progressive myelopathy and surgically treated deformities of the thoracic spine, lumbar spine, and right foot. Computer-assisted myelography indicated that the metal wire remained in place and that the syrinx had collapsed. Neurological examination and neurophysiological testing confirmed the presence of thoracic myelopathy, which may have been due to the wire tethering the thoracic spinal cord to the dorsal dura. This case is believed to be the only long-term report of the effects of the Echols procedure. The history of direct treatment of syringomyelia is reviewed and is contrasted with indirect treatment of syringomyelia, which relieves the condition by opening obstructed CSF pathways within the foramen magnum or spine.

Figure 1

Dean H. Echols, MD. Courtesy of The Ochsner Journal

Figure 2

(Left) Sagittal view of the stainless steel wire (arrows) with the Harrington rod (arrowheads) running posteriorly to it. (Right) Coronal view of the spinal cord where the steel wire at T10-11 is seen (arrow). Arrowheads show the Harrington Rod.

Figure 3

Upper and Lower Left: CT cuts at the T10-T11 level. A single Harrington rod (arrowheads) rests on a dorsal fusion mass. Metal wire (arrow) extends between the spinal cord and dura. Upper and Lower Center: CT Post-Myelogram, Axial Images. The metal wire (arrow) is again seen through the subarachnoid space and into the cord. The Harrington rod is represented by arrowheads. Right: Sagittal view of CT myelogram showing 2 mm of tonsillar ectopia and normal diameter of the cervical spinal cord.