Syringomyelia: a practical, clinical concept for classification
Christoffer Blegvad, J.A. Grotenhuis & Marianne Juhler
This review introduces an operational classification of syringomyelia to assist in diagnostic work-up and treatment by classifying the condition into four categories: 1) hydrocephalic; 2) related to hind-brain pathology; 3) related to spinal pathology; 4) idiopathic. The classifications is hierarchical and easy to use as clinical guidance.
Background
The term syringomyelia describes many pathogenetically different disorders, and a variety of attempts to group these based on different criteria have been proposed in the literature. As a consequence a lack of consensus regarding classification and terminology exists. This inconsistency extends to the ICD-10 classification of diseases in regards to syringomyelia (G95.0) and hydromyelia (Q06.4). We propose a new unifying concept for classification that also incorporates diagnostics and treatment.Methods
The PubMed online database was used to gain a general overview of the existing pathogenetic theories in relation to syringomyelia. Illustrative cases at our department were included and similar cases of the literature were found using the PubMed database. All material was reviewed with main focus on the classification and terminology used.Results
Despite syringomyelia (G95.0) and hydromyelia (Q06.4) existing as independent ICD-10 entities, we have shown that the use of classifying terminology for fluid-filled cavities in the spinal cord is indiscriminate and inconsistent. Even though a general agreement on the believed pathogenetic mechanism exists, and the general treatment methods are used in accordance with this mechanism, the terminology fails to function as a simple and universal link between theory and treatment.Conclusions
We propose a new causal concept for an ICD classification with syringomyelia (G95.0) as the only describing terminology, thus abandoning the use of hydromyelia (Q06.4). Syringomyelia is divided into five subgroups according to the associated pathologies. The classification is based on applied diagnostics and serves as a clinical guidance for treatment.Read the full paper in Acta Neurochirurgica (click here).