CASE REPORT: SYRINGOMYELIA EVALUATION AND MANAGEMENT
Viktor Vasilev, BS1, David Nguyen, MD2, Mike Martinez, DO3
1Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, Texas, USA
2Minivasive Pain & Orthopedics, Houston, Texas, USA
3Way Out West Spine + Mobility, Fort Worth, Texas, USA
Background:
•Syringomyelia is a cerebrospinal fluid (CSF) filled cavity in the spinal cord that can lead to a cystic structure called a syrinx.1
•Syringomyelia is commonly associated with Chiari malformation type 1 (CM-1), or a consequence of trauma, inflammation, or space-occupying lesions within the spinal cord.1
Objective:
Review common etiologies and management options for patients with syringomyelia.
Methods:
This case report consists of literature review alongside a clinical case. Patient informed consent was obtained prior to the case study.
Case Diagnosis:
Syringomyelia of the Cervical and Thoracic spine
Case Description:
•A previously asymptomatic, healthy 27-year-old female with no prior imaging presented to the pain management clinic with neck pain following a motor vehicle accident.
•The patient did not have any presenting motor or sensory deficits.
•Pain persistent despite adherence to physical therapy
•MRI of her Cervical spine showed a syrinx extending from C2 to T1 (Figure 1, Figure 2).
•MRI of her Cervical spine extension of the cerebellar tonsils into the spinal canal, supporting the diagnosis of a Chiari Malformation type 1 (CM-1) (Figure 1).
•The patient was managed conservatively with physical therapy, NSAIDs, physician-directed home exercises, and cognitive behavioral therapy.
•The patient had significant (over 50%) alleviation of her symptoms at 1 month follow-up visit.
Discussion:
•65% of patients with CM-1 are diagnosed with Syringomyelia.2
•22.7% of Syringomyelia cases are asymptomatic.2
•Common complaints include sensory deficits, weakness, neuropathic pain, spasticity, autonomic bladder dysfunction, and impaired ambulation.1
•MRI with and without contrast or CT Myelography are imaging modalities of choice.2
•Conservative measures, including physical therapy, cognitive behavioral therapy, and avoidance of activities that increase intracranial venous pressure have been noted to lead to substantial functional improvement in the management of patients with Syringomyelia.3
References:
1.Heiss JD, Snyder K, Peterson MM, Patronas NJ, Butman JA, Smith RK, Devroom HL, Sansur CA, Eskioglu E, Kammerer WA, Oldfield EH. Pathophysiology of primary spinal syringomyelia. J Neurosurg Spine. 2012 Nov;17(5):367-80. doi: 10.3171/2012.8.SPINE111059. Epub 2012 Sep 7. PMID: 22958075; PMCID: PMC3787878.
3.Ingale GD, Zade RJ, Timothy RP. Physiotherapeutic Intervention in a 19-Year-Old Female Patient With Syringohydromyelia: A Case Report. Cureus. 2023 Dec 12;15(12):e50419. doi: 10.7759/cureus.50419. PMID: 38222187; PMCID: PMC10784427.
Key Takaways:
•Syringomyelia is a common finding in patients with CM-1 and may be an incidental finding
•It can be challenging to discern this finding in the setting of trauma
•MRI and CT Myelography are the gold standard for diagnosis2
•Conservative management can play a crucial role in improving patients’ functional outcomes
•More data is necessary to assess the long-term functional outcomes of patients that undergo surgical versus conservative management
