FORAMINAL SYRINGOMYELIA - SUGGESTION FOR A GRADING SYSTEM

The standard treatment of foraminal syringomyelia includes foramen mag num decompression and duraplasty. Improvement or stabilization of the disease are achieved in most of cases. However, at least one third of patients are reported to receive little or no benefit. In this paper w e retrospectively reviewed a series of 40 consecutive foramen magnum d ecompressions in order to identify the possible pre-operative outcome predictors. Based on clinical evolution, neurological impairment and r adiological features, a scale of severity was fixed and retrospectivel y tested. A pre-operative score was obtained for each patient and was correlated with the surgical results. Then a four level grading system was derived. All grade I and grade II patients achieved good results (improvement or stabilization), whereas grade III patients showed inte rmediate behaviour and grade IV invariably worsened. On this basis, su rgical results of foramen magnum decompression might be further improv ed provided that a careful pre-operative selection is made.