Roentgen Therapy in Syringomyelia

THE symptomatic relief following x-irradiation of a majority of a group of some thirty cases presenting the clinical syndrome of syringomyelia, treated in our clinic, has been so striking that it seems impelling to again bring this method of therapeusis to the attention of the English-speaking profession. An original paper by Merrill (40), in 1924, who treated one case of syringomyelia with x-rays at the Massachusetts General Hospital, together with a translation of Delherm and Morel-Kahn's (13) original French article, comprise the entire contribution on the subject in English to date. On the other hand, the roentgen therapy of syringomyelia has been practised rather generally on the Continent since the original communication of Raymond (46), in 1905, with favorable results. Sahatchieff (51), after studying the published cases up to 1912, estimated that in 80 per cent of the subjects suffering from syringomyelia improvement had followed roentgen therapy. Keijser (29), in 1926, reported 53 personal cases treated by x-ray, two-thirds of which showed a more or less subjective improvement which had lasted five years. Objective improvement occurred in only 15 cases of his group. Delherm and Morel-Kahn (13, 14) observed 15 cases, nine of which (about 60 per cent) were improved, one unchanged, and five aggravated. Czerny and Heinismann (12) published in 1930 their experience in the treatment of 124 cases of syringomyelia. Seventy of these had been observed for from two to five years. Of this group, 75 per cent showed good results, 13 per cent were arrested, while 12 per cent progressed further. Most of their cases were in men occupied at hard labor in whom the disease existed for from one to twenty years. In their group were 12 cases of syringomyelia in which nystagmus, sensory involvement of the trigeminus, disturbances of speech and swallowing, dissociated sensibility and headache disappeared entirely. Motor disturbance of the trigeminus was not favorably influenced. These authors employed high voltage (180 K.V., 2.5 ma., and 0.5 Cu plus 1 Al filter) at a 45° angle, one-half to three-quarters E.S.D., not more than one-quarter skin dose daily, repeated at an interval of from one to three months. Repetition of the treatment was only done when the skin was perfectly normal. Markow, Gorjelik, and Liwschitz (37), in 1932, reviewed critically 30 cases of their own. These comprised 25 males and 7 females from 10 to 55 years of age in whom the disease had existed for from one to over ten years. They also utilized high voltage therapy (170 K.V., 3.5 ma., and 0.5 Cu plus 1 Al filter), but with vertical centralization of the rays over the affected vertebral segment, giving a 90 per cent E.S.D. in three sessions with an interruption of only one day between the treatments. Such a series was repeated after six to eight weeks if necessary.