Introduction: Various treatment modalities have been employed for managing syringomyelia and post-traumatic syringomyelia (PTS), emphasizing restoring cerebrospinal fluid (CSF) circulation at the injury site; however, the operative and non-surgical treatment outcomes remain inconclusive.
Methods: A comprehensive search was conducted on PubMed, Cochrane, Embase, Scopus, and Web of Science. We utilized proportions for single-arm analyses and risk differences (RD) for pairwise comparisons between surgical and non-surgical treatment, along with a 95% confidence interval (CI).
Results: Our analysis included 15 studies with a total of 888 patients. Overall, symptom improvement after surgery was 48.55% (95% CI 33.76; 63.45). Notably, 23.78% of patients showed no change in symptoms, while 29.52% experienced worsening. Specific improvements included syringomyelia size in 75.28% (95% CI 62.40; 84.82), pain in 53.15% (95% CI 33.62; 72.25), spasticity in 48.52% (95% CI 37.45; 59.74), sensory function in 40.99% (95% CI 30.57; 52.28), and motor function in 44.61% (95% CI 26.91; 63.79). Additionally, an analysis of three studies involving 148 patients, with 49% undergoing surgery, showed that surgery reduced the likelihood of no changes in symptoms by 44% compared to non-surgical treatment (RD -44.35, 95% CI -59.23; -29.46, p< 0.01). However, no significant differences were found in overall outcome improvement (RD -44.35, 95% CI -3.67; -84.95, p=0.07) or worsening (RD 18.83, 95% CI -27.5; 65.17, p< 0.42) between the groups.
Conclusion : Our analysis reveals that surgery significantly improves overall symptoms, especially in areas like syringomyelia size and pain relief. However, surgery may reduce the likelihood of unchanged symptoms compared to non-surgical treatment. Further robust clinical trials are warranted for more conclusive evidence.
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