Syringomyelia

What Is It?

Syringomyelia is a condition of the spinal cord which can result from various forms of injury to the spinal cord or spinal canal. It is characterized by the formation of a syrinx in the spinal cord, a fluid-filled cyst-like space within the substance of the spinal cord. As it slowly enlarges it can cause damage to the surrounding normal spinal cord leading to neurological symptoms.

There are several underlying causes that can lead to the formation of a syrinx:

Spinal Tumors: Tumors in or adjacent to the spinal cord can lead to a syrinx in the area.
Spinal Trauma: Trauma to the spinal cord, even relatively minor trauma, can lead to syringomyelia.
Congenital or Acquired Spinal Cord Lesions: Malformations such as Arnold-Chiari malformation and some forms of spinal dysraphism can lead to syrinx formation.
Other Causes: Other causes of injury to the spinal cord or narrowing of the spinal canal, including degenerative spine disease, can lead to a syrinx in some patients. Additionally, some cases appear to be idiopathic, meaning that no obvious cause for the syrinx can be found.

A persistent central canal of the spinal cord is sometimes misdiagnosed as a syrinx. Some individuals have a pronounced central canal which may be read as a syrinx by a radiologist. These findings are generally not associated with symptoms and do not enlarge over time as many syrinx do.

What Types of Symptoms Are Typical?

The symptoms associated with syringomyelia vary depending on their location and size. In general, enlargement of the syrinx can cause injury to the surrounding spinal cord, compromising nervous system function. This can lead to myelopathic symptoms which can include weakness, sensory symptoms (numbness, tingling, etc.), and bowel and bladder dysfunction. The muscle weakness is generally a spastic paralysis involving areas of the body below the level of the syrinx. A low cervical or thoracic syrinx may therefore lead to symptoms of the legs while a higher cervical syrinx can cause arm symptoms as well.

The symptoms associated with a syrinx are generally progressive as the syrinx enlarges over time, causing more compression and damage to surrounding nervous system structures.

How Is The Diagnosis Typically Made?

In a patient that presents with neurological symptoms consistent with spinal disease, after a neurological examination, an imaging study of the spine is typically performed. While a CT scan may be ordered in some cases, an MRI scan is much more sensitive with better resolution to demonstrate syringomyelia. It can both demonstrate the syrinx as well as any associated pathology such an associated tumor or compression.

In some cases a myelogram may be performed to assess the spinal canal at the level of the syrinx. This entails the injection of a radio-opaque dye into the cerebrospinal fluid in the spinal canal followed by imaging (either X-rays or CT scan, or both).

What Are Some Common Treatments?

The appropriate treatment of syringomyelia depends entirely on the patient's symptoms and the underlying cause of the syrinx in each case. For example, a syrinx associated with a tumor or focal spinal canal compression may be treated primarily by removal of the tumor or decompressive surgery, making room for the spinal cord and syrinx. In these cases, treating the underlying cause may be all that is required to halt the progression or even reverse the syrinx.

In cases which are refractory to other treatment or which are not associated with another lesion which can be treated, other treatment of the syrinx is occasionally necessary. For example, a syrinx shunt may be performed. Similar to a shunt performed for hydrocephalus. In these procedures, a small catheter is placed into the syrinx which diverts fluid to another location. This can be a shunt directly into the spinal canal or can shunt the fluid to the abdominal cavity where it can be re-absorbed.

These treatments aim to decrease the pressure within and around the syrinx, ideally shrinking it and preventing further enlargement and neurological injury.

The treatment of syringomyelia can be complex and varies from one patient to the next depending on location, size, underlying cause and symptoms. Each patient should consult their own treating physicians about the most appropriate treatment options in their specific case.

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Important Note: This site is not intended to offer medical advice. Every patient is different, and only your personal physician can help to counsel you about what is best for your situation. What we offer is general reference information about various disorders and treatments for your education.

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