Spinal cord size in syringomyelia: change with position on metrizamide myelography.

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Abstract
Change in the anteroposterior diameter of the cervical spinal cord was demonstrated on metrizamide myelography in 20 of 40 cases of cervical syringomyelia. Of these, 12 were normal-sized cords, 4 were small and 4 enlarged. Comparable lateral cervical myelograms in the prone and supine positions were sufficient to show size change for normal-sized or small cords. Additional myelograms in the erect and Trendelenburg positions were necessary to show size change in enlarged cervical cords, especially with associated Chiari malformation. A localized change in cord size suggests syringomyelia. If the change in cord size is diffuse, then change < 10% is not necessarily significant. In undiagnosed myelopathy, metrizamide myelography has the potential to detect unsuspected syringomyelia even when the cord is normal-sized or small. Myelographic study may also be useful as an adjunct to delayed computed tomographic studies.