Surgical procedures for patients with post-traumatic syringomyelia (PTS) remain controversial. Until now, there have been no effective quantitative evaluation methods to assist in selecting appropriate surgical plans before surgery.We consecutively enrolled PTS patients (arachnoid lysis group, n=42; shunting group, n=14) from 2003 to 2023. Additionally, 19 intrathecal anesthesia patients were included in the control group. All patients with PTS underwent physical and neurological examinations and spinal MRI preoperatively, 3-12 months postoperatively and during the last follow-up. Preoperative lumbar puncture was performed and BSCB disruption was detected by albumin quotient (CSF/serum, QAlb).The ages (P=0.324) and sex (P=0.065) of the PTS and CTRL groups did not differ significantly. There were also no significant differences in age (P=0.216), routine blood data and prognosis (P=0.399) between the arachnoid lysis and shunting groups. But the QAlb level of PTS patients was significantly higher than that of the control group (P<0.001), and the shunting group had a significantly higher QAlb (P<0.001) than the arachnoid lysis group. A high preoperative QAlb (OR=1.091, 95% CI 1.004-1.187, P=0.041) was identified as the predictive factor for the shunting procedure, with the ROC curve showing 100% specificity and 80.95% sensitivity for patients with a QAlb > 12.67.Preoperative QAlb is a significant predictive factor for the types of surgery. For PTS patients with a QAlb >12.67, shunting is an appropriate surgical option.