Syringomyelia (clinic, diagnosis, treatment tactics).

What is syringomyelia?

The spinal cord is an organ of the nervous system; it runs inside the spinal column from the cranial foramen, which communicates with the spinal column, to the first lumbar vertebra. Along its entire length - from the base of the skull to the coccyx, which ends the spinal column - sensory and motor nerves branch off from it. The structure of the spinal cord is the same as that of the brain - its central part, shaped like a butterfly, consists of gray matter with a predominance of nerve cells and a shell of white matter with a predominance of nerve fibers. The disease, in which a cyst-like cavity forms in the spinal cord, affects mainly the gray matter and is called syringomyelia , because the hole in the central spinal canal gives the spinal cord a flute-like appearance (in Greek, “syrinx”). In most cases, the origin of syringomyelia is unknown.

At our Institute, thanks to more than 40 years of research into the cause of Syringomyelia, a minimally invasive surgical technique has been developed for the treatment of idiopathic Syringomyelia: dissection of the filum terminale at the level of the sacrum with the unique Filum System® method (More information can be read below).

Fig. 1. – A 26-year-old man complains of loss of temperature sensitivity in the left half of the body and head, especially noticeable when taking a shower. The disease appeared a year ago. After surgical intervention - dissection of the terminal filum of the spinal cord - sensitivity was restored immediately after the operation. For 5 years after surgery, syringomyelia is practically asymptomatic.

Traditional medicines for hydromyelia

Folk remedies are often used to get rid of hydromyelia. Some of them are listed below.

Traditional methods will help you successfully cope with the disease.
Pine baths will be an excellent alternative. They improve the circulatory and metabolic systems. It is advisable to carry out therapy every day. To prepare a bath, you need to prepare a decoction of 500 g of pine needles, which is then added to a warm bath.

Are there any undesirable consequences of cutting this ligament?

The filum terminale is formed by the empty membranes of the spinal cord in its lowest section - the lumbosacral. In a human embryo, the vertebral column and spinal cord are the same length, and they are separated by membranes - hard, arachnoid and soft. During normal growth, the adult vertebral column is approximately 20 cm longer than the spinal cord. The membranes that separate the spinal cord from the spinal column in the sacrum and lumbar region, hard, arachnoid and soft, no longer contain the spinal cord and gather into something like a fibrous cord, forming the filum terminale; this end of the spinal cord resembles a sock that we pulled halfway onto our leg, and the empty part of this sock can be cut off without any harm to the leg. In the same way, the filum terminale of the spinal cord can be cut in any part without any consequences (1, 2).

Clinical picture

With hidradenoma, rashes often form on the skin of the eyelids or chest. Sometimes syringomas form on the abdomen, neck, arms, and rarely in the area of ​​the penis or vulva.

The main symptom of syringoma is the appearance of multiple tumor-like formations, oval or round in shape. As a rule, the size of the neoplasm does not exceed the head of a pin. However, sometimes syringomas grow to the size of a walnut.

The color of the tumor in hidradenoma is pink, yellowish, less often – bluish-red. Syringoma has a dense consistency and a smooth surface. Tumors are isolated and not prone to fusion.

Hidradenoma tumors, having reached a certain size, remain stationary for a long time. Self-resolution of hidradenoma is usually not observed. Syringoma has a benign course. Syringoma does not cause any subjective sensations (pain, itching).

To study Exercises for the spine on a gymnastic ball

Are there any other effects of spinal cord traction?

Tension of the filum terminale not only provokes syringomyelia , but also generates a flexion reflex in the spinal column, leading to scoliosis . To avoid strain on the spinal cord, it forces the lower part of the brain, the so-called tonsils of the cerebellum, to descend down the foramen magnum, through which the cranium communicates with the spinal column. This causes Arnold-Chiari malformation , a disease described 100 years ago, the cause of which remains unknown.

Treatment of myelitis

Treatment of myelitis depends on how much the spinal cord is affected and which segment of it is affected by inflammation. Acute myelitis is the most complex and severe form of the disease, in which the patient requires urgent surgical intervention. The operation eliminates pressure on the vertebrae and spinal canal, leading to pain. The high temperature that accompanies myelitis is relieved by a course of antibiotics and relief from inflammation.

Any myelitis requires urgent treatment, otherwise motor function may be lost forever. The course of myelitis therapy carried out with already bedridden patients includes measures to combat bedsores: treating the skin with camphor oil, regularly changing bed linen, placing rubber rings. If bedsores do appear, the damaged tissue is excised and a bandage is applied with Vishnevsky, penicillin or tetracycline ointment. Prevention of new bedsores is carried out using ultraviolet irradiation of the buttocks, sacrum and feet.

Along with bedsores, patients may experience dysfunction of the pelvic organs. The cause of these failures is an ascending urogenital infection that accompanies myelitis, which also needs monitoring and appropriate treatment. Initially, anticholinesterase drugs are used to remove urine. If they are ineffective, catheterization and rinsing of the bladder with antiseptic solutions is necessary.

To return the patient to full movement, the doctor prescribes dibazole, prozerin and vitamin B. Taking these medications is most often combined with passive gymnastics and therapeutic massage.

Myelitis in any form is an inflammatory disease that requires maximum doses of broad-spectrum antibiotics. To reduce the intensity of pain, antipyretics are used simultaneously with ACLT 40 units twice a day for 2-3 weeks and glucocorticoid hormones 50-100 mg per day. The latter can be replaced with dexamethasone or triamcinolone.

What happens to a syringomyelic cyst?

In syringomyelia , dissection of the filum terminale of the spinal cord delays the development of the disease. A cyst formed as a result of cell death may remain unchanged, but it may disappear with the spontaneous opening of the space surrounding the spinal cord, or it may move into its central canal, where there is an ependymal canal, through which the central canal of the spinal cord communicates with the cavities of the brain . Syringomyelia symptoms are caused by cell death and the toxic tumor effect of the cyst. Cutting the filum terminale of the spinal cord has two beneficial effects: it delays cell death that was caused by the tension on the spinal cord, and it reduces the toxic tumor effect of the cyst on the spinal cord.

Treatment of the disease

One of the features of this disease is that it does not always manifest itself in the form of any symptoms. A person may not even know that he is sick. If the disease is accidentally discovered during an MRI, treatment is usually not performed.

To study Chondrosis of the thoracic region: symptoms

Otherwise, when the disease develops quickly and makes itself felt, treatment is selected by a neurologist and neurosurgeon

This disease must be treated with great care due to the fact that it mainly develops in such “problem” areas as the neck or back

To treat the disease, you must first identify and correct the cause of the problematic circulation of cerebrospinal fluid. This is easy to do if hydromyelia occurs due to infectious diseases, inflammatory processes, injuries or hemorrhages.

In the case of tumor and metastatic lesions, it is necessary to first surgically remove the tumors, and then treat the consequences of hydromyelia. If the pathology is congenital, treatment is difficult, but in some cases reconstructive neurosurgical operations can alleviate the condition.

In general, the disease can be eliminated by normalizing the circulation of cerebrospinal fluid. This occurs through the installation of a special shunt, thanks to which it is possible to establish the outflow of fluid from the spinal canal.

Hydromyelia that develops in the thoracic or cervical spine can be treated with shunt surgery. But there are cases when therapy is carried out with the help of medications. Most often, the patient is prescribed Dibazol, Milgamma and Diacarb. These drugs must be administered intramuscularly. The dosage is selected by the doctor individually for each patient.

To alleviate the condition, the patient is recommended to regularly engage in simple exercises or yoga. The most useful exercises will be squats and torso bends.

It is important to remember that they must be done extremely carefully, without sudden movements - otherwise the condition may only worsen.

It is also important to improve nutrition: to do this, you need to exclude “harmful” foods from your diet, for example, fried, smoked and fatty foods and switch to cereals, fruits and vegetables. You need to eat often, but rarely: for example, 5-6 times a day in portions of 200-300 g

An unconventional technique, hirudotherapy, is often used. Thanks to hirudin, which is released by medicinal leeches when they “suck” onto the patient’s skin, blood circulation improves and metabolism accelerates, which has a positive effect on both the general condition and getting rid of the disease. Many patients are afraid of this method because they believe that it is unhygienic, but this is a misconception - each leech is used only once in a lifetime, after which it is disposed of.

If you start treatment in a timely manner and carry it out correctly, you can avoid the progression of hydromyelia and the worsening of the situation.

Bibliography

1. Dr. Miguel B. Royo Salvador (1996), Siringomielia , escoliosis y malformación de Arnold-Chiari idiopáticas, etiología común (PDF). REV NEUROL (Barc); 24 (132): 937-959.
2. Dr. Miguel B. Royo Salvador (1996), Platibasia , impresión basilar, retroceso odontoideo y kinking del tronco cerebral, etiología común con la siringomielia , escoliosis y malformación de Arnold-Chiari idiopáticas (PDF). REV NEUROL (Barc); 24 (134): 1241-1250
3. Dr. Miguel B. Royo Salvador (1997), Nuevo tratamiento quirúrgico para la siringomielia , la escoliosis , la malformación de Arnold-Chiari , el kinking del tronco cerebral, el retroceso odontoideo, la impresión basilar y la platibasia idiopáticas (PDF). REV NEUROL; 25 (140): 523-530
4. M. B. Royo-Salvador, J. Solé-Llenas, J. M. Doménech, and R. González-Adrio, (2005) “Results of the section of the filum terminale in 20 patients with syringomyelia , scoliosis and Chiari malformation .” (PDF). Acta Neurochir (Wien) 147:515–523.
5. M. B. Royo-Salvador (1992), “Aportación a la etiología de la siringomielia ,” Tesis doctoral (PDF). Universidad Autónoma de Barcelona.
6. M. B. Royo-Salvador (2014), “Filum System® Bibliography” (PDF).
7. M. B. Royo-Salvador (2014), “Filum System® Guía Breve.”

Causes

The main cause of this condition is autoimmune processes, in which the body’s own immune system destroys its own cells.
The consequences of such destruction are irreversible. In this case, the nervous tissue no longer has the ability to transmit nerve impulses. Typically, the disease always has its own risk factors, but the main cause of all these pathologies remains unclear. Risk factors include:

1. Heredity.
2. A viral infection, most often cytomegalovirus or rubella.
3. The presence of chronic foci of infection.
4. Poisoning with metals, gasoline, solvents.
5. Stress.
6. Food with a predominance of proteins and fats of animal origin.
7. Unfavorable environmental conditions in the area of ​​residence.

All pathologies that lead to the destruction of the myelin sheath can be divided into several large groups. This is what helps determine what could have caused the disease.

Recovery and rehabilitation

Despite reports of complete neurological recovery after surgery, most patients experience stable or only moderate improvement in symptoms. Syringomyelia in children is characterized by much less pronounced sensory and pain disturbances than in adults, but a much greater risk of developing scoliosis, which is more favorable for surgical treatment. In addition, syringomyelia does not progress equally in all patients. Some patients, usually those with milder symptoms, experience stabilization of symptoms over the course of 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 result in a loss of quality of life. The goal of rehabilitation is to preserve functionality as much as possible using exercises and adaptive equipment, or, especially in the case of syringomyelia in children, activities should be aimed at correcting scoliosis.