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Syringomyelia Pain

syringomyelia pain

The term syringomyelia includes various conditions that are characterized by damage to the spinal cord with the formation of abnormal fluid-filled cavities.

Cavities in the spinal cord can be the result of a spinal cord injury, a spinal tumor, or a congenital anomaly. Also described in the clinic is the idiopathic form of the syrinx (a form of the disease without a specific cause). Fluid-filled cavities slowly expand and lengthen over time, resulting in progressive damage to the nerve centers of the spinal cord due to the pressure exerted by the fluid. This injury results in pain, weakness, and stiffness in the back, shoulders, arms, or legs. Syringomyelia patients can have a different combination of symptoms. In many cases, the syrinx is combined with an anomaly of the foramen magnum, where the lower part of the medulla oblongata is located, which connects the brain and spinal cord. Syrinx is often combined with Chiari malformation, in which part of the brain is displaced down to the medulla oblongata, thus reducing the spinal central canal. Familial cases of syrinx are also sometimes observed.

The types:

  • with communication with the fourth ventricle;
  • due to CSF ​​block (without connection with the fourth ventricle);
  • due to spinal cord injury;
  • syrinx and spinal dysraphism (incomplete closure of the neural tube);
  • due to intramedullary tumors;
  • idiopathic syrinx;
  • syrinx occurs in about eight out of every 100,000 people. The onset of the disease is most often noted between the ages of 25 and 40. Rarely, syringomyelia can develop in childhood or old age. Men get this disease more often than women. No geographic or racial dependence was noted.

Symptoms and causes of syringomyelia pain

Symptoms and causes of syringomyelia pain

Symptoms

The patient should pay attention to the following changes in his body:

  1. Loss of pain (and temperature) sensitivity in certain areas of the skin, primarily in the upper half of the body.
  2. The spread over time of insensitive areas throughout the body, alternating with normal areas.
  3. Deep pains of unknown origin, which seem to shoot unexpectedly in different parts of the body.
  4. Persistent, increasing weakness in the muscles, starting in the hands.
  5. Dryness, flaking, and bluish tint of the skin due to weakening of peripheral circulation, a sharp deterioration in the condition of the nails.

Causes

The causes of syrinx remain unknown. At present no theory can correctly explain the basic mechanisms of the formation of cysts and cystic enlargements. 

  1. One theory suggests that syrinx occurs as a result of the pulsating pressure of the cerebrospinal fluid between the fourth ventricle of the brain and the spinal central canal
  2. Another theory suggests that cysts develop due to differences in intracranial pressure and spinal pressure, especially in the presence of Chiari malformation. 
  3. The third theory suggests that the formation of cysts is caused by the tonsils of the cerebellum, acting as a piston and there is a large pressure drop of the cerebrospinal fluid in the subarachnoid space, and this action of the forces of fluid affects the spinal cord. 

It usually progresses slowly, and the course of the disease stretches for years. But sometimes there is an acute course of the disease, especially when the brain stem is involved.

Diagnostics and treatment of syringomyelia pain

Diagnostics

Diagnosis begins with a medical history and a complete physical examination.

At the initial visit, the doctor will examine the patient for the presence of four main symptomatic groups of syringomyelia:

  • The presence of a complex of congenital malformations called dysgraphic status: split palate, cleft lip, deformities of the skull, spine – in 90% of patients with syringomyelia;
  • Sensitivity disorders of any type, primarily temperature and pain sensitivity – in 100% of patients with syringomyelia, however, may not always be noticeable to the patient;
  • Various disorders of motor function: weakness in the hands, up to paralysis – in 90% of patients with syringomyelia;
  • Vegetative-trophic syndrome – in 60% of patients with syringomyelia.

Sometimes syringomyelia is an accidental finding during MRI (magnetic resonance imaging) or CT (computed tomography) of the spine for another reason.

If you suspect syringomyelia, your doctor is likely to order the following tests:

  1. MRI of the spine and spinal cord is the most reliable tool in this diagnosis. During an MRI, radio waves and a strong magnetic field are used to produce detailed images of the spine and spinal cord. In some cases, contrast enhancement is used – a specialist injects a dye into a blood vessel, which goes along the circulatory system to the spine and allows you to detect tumors or other anomalies. MRI is repeated periodically to monitor the progression of the disease.
  2. CT – A series of X-rays are used to display the spine and spinal cord in detail. CT can detect tumors or other pathologies of the spine.

Treatment

Syringomyelia treatment, usually surgical, is aimed at arresting the progression of the spinal cord injury and maintaining functionality. 

  1. Surgical procedures are often performed when there is spinal cord compression. 
  2. In addition, surgical procedures are performed to correct deformities. 
  3. Operations were also performed to implant fetal tissues to close the cystic formations. 
  4. Surgical treatment results in stabilization or moderate improvement in symptoms in most patients. 
  5. Many doctors believe that surgical treatment is only necessary for patients with progressive neurologic symptoms. 
  6. Delay in surgical treatment in cases where the disease progresses can lead to irreversible damage to the spinal cord and gross persistent neurological damage.

Medication (vasoconstrictors) is often prescribed to reduce swelling around the spinal cord. It is often recommended to avoid vigorous physical activity that can increase venous pressure. Some exercises, such as forward bending of the trunk, can reduce the risk of cystic enlargement. Life expectancy in patients with progressive symptoms without surgery ranges from 6 to 12 months.

Rehabilitation and prognosis of syringomyelia pain

Syringomyelia treatment, usually surgica

Recovery and rehabilitation

Despite reports of complete neurological recovery after surgery, most patients manage to achieve stabilization or only moderate improvement in symptoms. Syringomyelia in children is characterized by much less pronounced sensory and pain disorders than in adults, but a much higher risk of developing scoliosis, which is more favorable for surgical treatment. In addition, syrinx does not progress equally in all patients. For some with milder symptoms, symptoms stabilize for a year. A frequent complication of the progression of symptoms is the patient’s need to adapt to life due to impairment or loss of some functions. These adjustments can lead to a loss of quality of life. The goal of rehabilitation is the maximum possible preservation of functionality using exercises and adaptive equipment, or, especially in the case of syringomyelia in children, measures should be aimed at correcting scoliosis.

Prognosis

The prognosis for patients depends on the underlying cause of the cyst and the type of treatment. Untreated cases of the syrinx in 35-50% of cases have a prognosis for long-term survival. Patients who underwent surgical bypass surgery for spinal cord injury experienced long-term pain relief and better survival. Recent studies have shown an unsatisfactory long-term prognosis due to the high rate of recurrence of cyst formation in other forms of syringomyelia. Surgical treatment (posterior decompression) associated with Chiari malformation is considered a fairly effective treatment with a high chance of clinical improvement. In children, surgical treatment is effective for stabilizing scoliosis.

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Lone Star Neurology
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Edward Medina
Edward Medina
15:34 30 Jun 22
Just such an amazing staff that makes you feel like part of their family. I’ve been going there for over 5 years now... and each visit I get the very best care and treatments that I have ever received in the 20+ years that I’ve been dealing with severe debilitating migraines. Since i started seeing them the number of my migraines has dropped from 15-20 a month to 2-3 every 3 month. I highly recommend them …they will change your life!read more
Daneisha Johnson
Daneisha Johnson
22:20 19 May 22
Dr. Askari was very kind and explained everything so I could understand. The other staff were nice as well. I would... have gave 5 stars but I was a little taken aback when I checked in and had to pay 600.00 upfront. I think that should have been discussed in a appointment confirmation call or email just so I could have been prepared.read more
Jean Cooper
Jean Cooper
16:54 29 Apr 22
I love the office staff they are friendly and very helpful. Dr. JODIE is very caring and understanding to your needs... and wants to help you. I will go back. would recommend Dr. Dr. Jodie to other Patients in a heart beat. The team works well together.read more
Linda M
Linda M
19:40 02 Apr 22
I was obviously stressed, needing to see a neurologist. The staff was so patient and Dr. Ansari was so kind. At one... point he told me to relax, we have time, when I was relaying my history of my condition. That helped ease my stress. I have seen 3 other neurologists and he was the only one who performed any assessment tests on my cognitive and physical skills. At one point I couldn't complete two assessments and got upset and cried. I was told, it's OK. That's why you're here. I was truly impressed, and super pleased with the whole experience!read more
Leslie Durham
Leslie Durham
15:05 01 Apr 22
I've been coming here for about 5 years. The staff are ALWAYS friendly and knowledgeable. The Doctors are the absolute... best!! Jodie Moore is always in such a great mood which is a plus when you are already stressed. Highly recommendedread more
Monica Del Bosque
Monica Del Bosque
14:13 25 Mar 22
Since my first post my thoughts have changed here. It's unfortunate. My doctor and PA were great, but the office staff... is horrible. They never call you back when they say they will, they misinform you, they cause you too much stress wondering what's going on, they don't keep you posted. They never answer the phone. At this point I've left four messages in the last week, and I have sent three messages. Twice from their portal and one direct email. No response. My appointment is on Monday morning at 8:30am, no confirmation on my insurance and what's going on. What the heck is going on, this is ridiculous!I've given up... the stress her office staff has put me through is just not worth it. You can do so much better, please clean house, either change out your office staff, or find a way for them to be more efficient please. You have to do something. This is not how you want to run your practice. It leaves a very bad impression on your business.read more
Ron Buckholz
Ron Buckholz
23:32 23 Mar 22
I was actually pleasantly surprised with this visit! It took me a long time to get the appointment scheduled because no... one answers your phones EVER! After a month, I finally got in, and your staff was warm, friendly, and I was totally impressed! I feel like you will take care of my needs!read more
Steve Nabavi
Steve Nabavi
16:28 16 Mar 22
It was a nice visit. Happy staff doing all they can do to comfort the patients in a very calming environment. You ask... me they are earned a big gold star on the fridge. My only complaint they didn't give me any cookies.read more
Katie Lewis
Katie Lewis
16:10 10 Feb 22
Had very positive appointments with Jodie and Dr. Sheth for my migraine care. Jodie was so fast with the injections and... has so much valuable info. I started to feel light headed during checkout and the staff was SO helpful—giving me a chair, water, and taking me into a private room until I felt better. Highly recommend this practice for migraine patients, they know what they’re doing!!read more
Joshua Martinez
Joshua Martinez
16:02 10 Dec 21
I was scheduled to be checked and just want to say that the staff was fantastic. They were kind and helpful. I was... asked many questions related to what was going on and not once did I feel as though I was being brushed off. The front desk staff was especially great in assisting me. I'm scheduled to go back for a mri and am glad that I'll be going there.read more
Isabel Ivy
Isabel Ivy
21:42 03 Nov 21
I had such a good experience with Lone Star Neurology, Brent my MRI Tech was so awesome and made sure I was very... comfortable during the appointment. He gave me ear plugs, a pillow, leg support and blanket, easiest MRI ever lol 🤣 My 72 hour EEG nurse Amanda was also so awesome. She made sure I was take care of over the 3 days and took her time with the electrodes to make sure it was comfortable for me! Paige was also a huge help in answering all my questions when it came to my test results, and letting me know her honest opinions about how I should go forth with my treatment.read more
Leslie Luce
Leslie Luce
17:37 20 Oct 21
The professionalism and want to help attitude of this office was present from the moment I contacted them. The follow... up and follow through as well as their willingness to find a way to schedule my dad was above and beyond. We visited two offices in the same day with the same experience. I am appreciative of this—we spend a lot of time with doctors and this was top notch start to finish.read more
robert Parker
robert Parker
16:38 16 Apr 21
I love going to this office. The staff is friendly and helpful. The doctor is great. I am getting the best... neurological tests and treatment I have ever had. The only reason I did not give them a 5 star rating is because it is impossible to reach a live person at the office to reschedule appointments. Every time I have tried to get through to the office it says all people are busy and I am sent to a voicemail. If they could get their phone answering fixed, I would give them a strong 5 stars.read more
MaryAnn Hornbaker
MaryAnn Hornbaker
00:26 25 Feb 21
Dr. Harney is an excellent Dr. I found him friendly , personable and thorough. I evidently am an unusual case. ... Therefore he spent a Hugh amount of time educating me. He even gave me literature to further explain my condition and how to follow up. This is something you rarely get from your doctors. So I am more than please with my doctor and his staff.read more
Roger Arguello
Roger Arguello
03:05 29 Jan 21
Always courteous, professional. The staff is very friendly and always work with you to find the best appointment time.... The care team has been great. Always taking the time to listen to your concerns and to find the best treatment.read more
Margaret Rowland
Margaret Rowland
01:12 27 Jan 21
I have been a patient at Lone Star Neurology for several years. Now both my adult daughters also are patients there. I... love Jodie. She is always so prompt whether it is a teleamed call are a visit in the office. She takes the time to explain everything to me and answers all my questions. I am so blessed to have Jodie as my doctor.read more
Susan Miller
Susan Miller
03:01 13 Jan 21
My husband had an accident 5 years ago and Lone Star Neurology has been such a blessing to us with my husbands care.... Jodie Moore is his provider and she is amazing! Jodie is very knowledgeable, caring, and thorough. She takes her time with you, making sure your needs are met and she is happy to answer any questions you may have. Lone Star Neurology’s patients are very lucky to have Jodie providing their care. Thank you Lone Star Neurology and especially Jodie for everything you have done for us. Jodie, you are the best!read more
Windalyn C
Windalyn C
01:32 09 Jan 21
Jodie is wonderful. She is very caring and knowledgeable. I have been to over a dozen neurologists, and none were able... to help me as much as they have here. Thanks!read more
Katie Kordel
Katie Kordel
00:40 09 Jan 21
Jodi Moore, nurse practitioner, is amazing. I have suffered from frequent, debilitating headaches for almost 20 years.... She has provided the best proactive and responsive care I have ever received. My quality of life has been greatly improved by her caring approach and tenacity in finding solutions.read more
Ellie Natsis
Ellie Natsis
15:41 07 Jan 21
I have had the best experience at this neurologist's office! For over a year I have been receiving iv treatments here... each month and my nurse, Bobbie is beyond wonderful!! She's so attentive, knowledgeable, caring, and detail oriented. She makes an otherwise uncomfortable experience much more pleasant and definitely puts me at ease! She also helps me with my insurance,ordering this specialty medication and dealing with the ordering process which is no easy feat.Needless to say, she goes above a beyond in every way and I'm so grateful to this office and to Bobbie for all they do for me!read more
Matt Morris
Matt Morris
15:39 07 Jan 21
Let me start by saying that I have been coming here for years. Due to my autoimmune disease, I am in this office... once every three weeks for multiple hours at a time. The office is very clean and the staff very friendly. My only complaint would be there communication via phone. They aren't the best at responding if you leave a voicemail and expect a call back. I understand that this is prob just due to the sheer number of alls they receive daily. What I can say I like the best about the office are the people. Bobby who handles my infusions is great. I never have any issues with her setting up my infusions. She is very quick to reply to messages sent via text and if she were to leave then my whole opinion of the office may change. I also enjoy people like Matt, Lauren, and Jodi. I appreciate all that they do for me and without this team I'm not sure I would be as happy as I am to visit the office as frequently as I have to. Please ensure that these folks are recognized as they are what makes my visit to this office so tolerable :).read more
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