In 1974, a 9-year-old girl with syringomyelia and scoliosis was treated using the Echols procedure, a surgical technique that makes use of a metal stent to maintain drainage of fluid from the syrinx into the subarachnoid space. The patient presented to the authors' institution 34 years later with a history of progressive myelopathy and surgically treated deformities of the thoracic spine, lumbar spine, and right foot. Computer-assisted myelography indicated that the metal wire remained in place and that the syrinx had collapsed. Neurological examination and neurophysiological testing confirmed the presence of thoracic myelopathy, which may have been due to the wire tethering the thoracic spinal cord to the dorsal dura. This case is believed to be the only long-term report of the effects of the Echols procedure. The history of direct treatment of syringomyelia is reviewed and is contrasted with indirect treatment of syringomyelia, which relieves the condition by opening obstructed CSF pathways within the foramen magnum or spine.