The natural history of syringomyelia

A retrospective analysis was made of the clinical course in 24 patients with syringomyelia who had not been treated surgically. 5 patients died during follow-up, and the survivors were followed for 1 to 37 (median 9) years after diagnosis. 8 of the 19 survivors followed a slowly progressive course over 4 to 46 (median 27) years but only 3 were severely disabled. 3 patients had an intermittent progression of symptoms, often with long intervening periods of stability. 8 patients had no progression in symptoms after presentation; none of these patients was severely disabled at last follow-up. It is concluded that the natural history of syringomyelia is unpredictable. Some patients have no further progression in symptoms for many years after onset. Prolonged survival is usual even among those patients with a slowly progressive deficit. The uncertain progression of the clinical course presents considerable difficulties in the timing of surgical intervention and in interpretation of the results.