Syringomyelia is the term for damage to the spinal cord which has been caused via the formation of a fluid filled area within the spine. This fluid filled area is a cyst or syrinx and can expand and elongate over time causing damage to the spinal cord. This damage can result in pain and eventually even paralysis if it is left untreated. Though there are many common symptoms, the precise effects will vary from patient to patient depending on the position and size of the swelling.
Syringomyelia is believed to affect around 8.4 in every 100,000 people and is most common in young adulthood. Symptoms can come on slowly or with a sudden onset. At first there may be no symptoms, or they may be any or all of the following.
• Loss of muscle mass
• Numbness – decreased ability to feel pain or temperature or even complete loss of sensation. Often in a ‘cape’ pattern across the back
• Pain – particularly in the arms, neck and upper back
• Loss of muscle function – paralysis of independent limbs or complete loss of movement
• Muscle contractions
• Spasms particularly in the legs
• Lack of coordination
Following these symptoms diagnosis will involve a neurological examination and this might show loss of sensation/movement caused by compression in the spinal cords. An MRI (Magnetic Resonance Imaging) scan can then be used to identify the syringomyelia and to find the size and position of the problem. MRI will also be used to look for other associated problems such as water on the brain.
Progression of the condition is normally very slow, but left untreated it can result in severe disability.
There are two main causes for syringomyelia and two forms of the condition as a result. These are ‘congenital’ and ‘acquired’ (though sometimes it will also be referred to as ‘syringobulbia’ in which case it affects the brain stem and thereby controls many of the body’s vital functions).
In congenital syringomyelia the condition is related to a brain abnormality referred to as a ‘chiari malformation’. This is the more common form of syringomyelia. Here the abnormality causes the lower aspect of the cerebellum to protrude out of its usual location in the back of the head and into the cervical neck portion of the spinal canal. This can then cause the syrinx to develop in the cervical region of the spinal cord. This form is more likely to occur between the age of 25-40 and worsens with straining and activity.
In acquired syringomyelia, as the name suggests, an outside factor leads to the formation of the syringomyelia. This can be a result of a complication due to trauma, meningitis, tumor, arachnoiditis or hemorrhage. The syrinx or cyst then develops into a segment of the spinal cord where this damage occur before expanding. It may be years after the trauma before the symptoms emerge.
Treatment for the problem will usually involve using a neurosurgeon and surgery is the only viable treatment for the condition. Surgery however will only be used if a patient has advanced to a point where it is needed and patients will not always get to this point. In such cases management techniques will be used in order to reduce damage and prevent the condition from progressing. This can involve physical therapy in order to help improve muscular function. However evaluation can sometimes be complicated due to the sometimes intermittent nature of the progress. Medication can also be used in order to treat back pain and neuropathic pain symptoms such as shooting or stabbing pain.
Should you go ahead with surgery this can result in stabilization of the condition and often modest improvement. However the location of the cyst and irreversible spinal damage can make surgery difficult or might require additional operations. There is a high risk associated with any spinal surgery. If a tumor is present then surgery can be used to remove this. Surgery will also involve the draining of the syrinx, and in some cases this will use a ‘shunt’ which is a catheter with drainage tubes and valves. This can then help to prevent the progression of the symptoms and relieve pain etc. However at the same time it further increases the risk of spinal cord injury as well as increasing the likelihood of infection, blockage and hemorrhaging.