Table 20. Systematic Review of Syringomyelia and Tethered Spinal Cord

Author Year

Research Design
Sample Size

Methods Outcomes

Bonfield et al., (2010a)


Systematic Review


N=22 studies

Objective: To determine the indications for surgical intervention and optimal surgical intervention technique for post-traumatic syringomyelia (PTS).

Methods: Comprehensive literature search of English articles of all individuals with traumatic syrinx, excluding case reports.

Databases: MEDLINE, EMBASE, Cochrane, Web of Science.

Evidence: Levels of evidence were assigned using GRADE criteria (very low, low, moderate, or high). Clinical recommendations were made using a modified Delphi approach (weak or strong).


1.     Strength of evidence was very low (n=16) to low (n=6).

2.     Overall recommendations were weak.

3.     The incidence of PTS was 0.5-4.5% and was twice as common in complete versus incomplete injury.

4.     Surgical intervention for PTS was effective at arresting or improving motor deterioration, but not sensory dysfunction or pain syndromes.

5.     Spinal cord untethering with expansile duraplasty was the preferred surgical technique.

6.     Direct surgical decompression beyond realignment/stabilization of a thoracic complete SCI to reduce the risk of future PTS was not supported.

7.     Surgical intervention for incidental, asymptomatic syrinx was not supported.