Syringomyelia

The spinal cord is connected to the lower part of the brain, called the brainstem, and is a delicate structure that rests within the spinal canal. In adults, the spinal cord is surrounded by cerebrospinal fluid (CSF). Syringomyelia is a condition that occurs when that spinal fluid also collects inside the spinal cord, in a blister-like cyst called a syrinx.

Many nerves originate in the spinal cord. As the syrinx swells, it causes pressure from the inside of the spinal cord and disrupts the normal function of those nerves.

The syrinx can also enlarge over time and stretch the delicate nerves that run in the spinal cord, but there is no specific, predictable pattern of enlargement of the syrinx cavity. Some syringes remain unchanged for many years, while others may enlarge over a short period of time.

The exact cause of syringomyelia is not known. In general, it is believed that the Chiari malformation blockage of normal spinal fluid flow at the foramen magnum results in fluid collecting inside of the spinal cord. So you might say that a common cause of syringomyelia is the Chiari malformation. However, not everyone who has Chiari malformation will develop syringomyelia.

In some cases, the cause of the syrinx is simply unknown, but other causes of syringomyelia include:

• Arachnoiditis
• Lesions inside the spinal canal
• Spinal tumors
• Spine or spinal cord injuries

Diagnosing a syrinx is typically done with magnetic resonance imaging (MRI) of the spine.

The most common area for a syrinx to develop in persons with Chiari malformation is in the cervical spine (neck). A syrinx can also develop in the thoracic spine. As the syrinx grows in size, it may cause scoliosis, which is best evaluated with special spinal X-rays.

Once a proper diagnosis has been reached, we can move forward with a individualized treatment plan designed to fit your unique condition.

Many of the symptoms of syringomyelia may be vague and variable at first, however they can be progressive over a long period of time. Some people experience symptoms that occur suddenly, and some report symptoms starting after a minor injury.

Pain

Pain is one of the most common syrinx symptoms. You may complain of pain in the arm, hand or leg, or possibly a burning sensation around the ribs, neck or back. Often the pain is present for months to years before a proper diagnosis is made. Pain can also be described as dull and aching, or stabbing. Pain on one side of the body (unilateral) is more common than on both sides (bilateral).

Tingling or numbness

Often called paresthesia, you may report a tingling sensation in the arm, chest, back, leg or foot. If left unchecked, it can lead to burning or injury, without even realizing it, due to numbness.

Weakness

Another common symptom is weakness in the hand, arm, leg or foot. Weakness is generally progressive over time, and many people will say they have become clumsy with their fine motor movements. Over time, if untreated, you can develop muscle wasting (atrophy), as well as problems with walking (called ataxia), even frequent falling.

The best treatment for syringomyelia is to remove the blockage of the normal spinal fluid flow, if there is one.

So, if syringomyelia is caused by a blockage related to a Chiari malformation type I, we use a decompression technique to create more room at the foramen magnum. For many, the improved spinal fluid flow will result in the syrinx slowly decreasing in size, although it may not disappear completely. Our objective is to keep the syrinx from growing and allow it to relax and decrease in size.

When syringomyelia occurs due to spinal injury, release of the scar bands around the spinal cord can result in a decrease in the size of the syrinx.

When the syrinx developed as a result of a spinal cord tumor, the best course of treatment is typically using syrinx surgery to remove the tumor, if possible.

When the cause of the syrinx is not known, the treatment decisions are more difficult. Some may respond to sectioning the band at the end of the spinal cord, the filum terminale, if it is tethered. If the syrinx is small and the symptoms are under control, observation and follow-up MRI scans may be the best option.