Context: Post-traumatic syringomyelia treatment usually focuses on restoring normal cerebrospinal fluid (CSF) flow. Herein, the first-reported case of delayed post-traumatic syringomyelia associated with an L2 compression fracture 30 years prior to syringomyelia symptoms that rapidly progressed to the brainstem within 5 months, leading to respiratory and circulatory impairments, is summarized. The improvement in symptoms and significant decrease in size of the syringomyelia/syringobulbia achieved in this patient suggest that the initial treatment of choice in such acute cases should be posterior fossa decompression (PFD). Intradural exploration in order to restore the normal CSF flow at the level of trauma can then be planned in a later time.

Findings: A retrospective analysis of clinical manifestations and findings obtained from magnetic resonance (MR) imaging, including pre-operative and post-operative follow-up data acquired 6 months later, provided adequate comparisons of the neurological deficits and syrinx size. Interestingly, serial MR images showed that a cervical syrinx acutely progressed to the brainstem within 5 months. PFD and sectioning of the thick veil completely obstructing the foramen of Magendie resulted in partial resolution of the neurological deficits and syringomyelia regression after surgery.

Conclusions: To our knowledge, this is the first case report to summarize the delayed complications of a spinal cord injury and acute syringomyelia progression to the brainstem in a short period. The symptoms were relieved by an emergency PFD, chosen due to the rapid progression of symptoms. An atypical treatment strategy is described for extremely rare cases, but with a good short-term prognosis.

背景：创伤后脊髓空洞症的治疗通常侧重于恢复正常的脑脊液 (CSF) 流动。本文总结了首例与 L2 压缩性骨折相关的外伤后延迟性脊髓空洞症病例，该病例发生在脊髓空洞症症状出现前 30 年，该症状在 5 个月内迅速进展至脑干，导致呼吸和循环障碍。该患者症状的改善和脊髓空洞/延髓空洞大小的显着减小表明在这种急性病例中选择的初始治疗应该是后颅窝减压（PFD）。然后可以计划在以后的时间进行硬膜内探查以恢复创伤水平的正常脑脊液流动。

结果：对临床表现和磁共振 (MR) 成像结果的回顾性分析，包括 6 个月后获得的术前和术后随访数据，提供了对神经功能缺损和空洞大小的充分比较。有趣的是，连续 MR 图像显示颈部空洞在 5 个月内急性进展到脑干。PFD 和完全阻塞 Magendie 孔的厚面纱切片导致手术后神经功能缺损和脊髓空洞症的部分消退。

结论：据我们所知，这是首例总结脊髓损伤延迟并发症和急性脊髓空洞症在短期内进展至脑干的病例报告。由于症状的快速进展，选择了紧急 PFD，症状得到缓解。对于极其罕见的病例，描述了一种非典型的治疗策略，但具有良好的短期预后。