Overview
This lecture covers post-traumatic syringomyelia, its clinical presentation, surgical management options, and the challenges associated with its treatment.
Clinical Presentation of Syringomyelia
- Syringomyelia is a late complication of spinal cord injury.
- Common symptoms include chronic pain, motor deficits, and sensory loss.
- Classic sensory loss is "dissociated," meaning loss of pain and temperature sensation with preserved light touch (intact dorsal columns).
- Less commonly, patients can have a complete sensory level affecting all modalities.
- Motor symptoms may result from injury to the lateral corticospinal tract.
- Other possible symptoms: hyperhidrosis (excess sweating), autonomic dysreflexia, Horner’s syndrome, respiratory problems, and (if high enough) cranial nerve involvement.
Surgical Management and Outcomes
- Surgery aims to stabilize disease progression rather than restore function or eliminate pain.
- Surgical options: spinal decompression, percutaneous drainage, syrinx shunting, lysis of adhesions, expansion duroplasty, and cord detethering.
- Procedures carry limited efficacy and frequent symptom recurrence.
- The risks of surgery must be weighed carefully against potential benefits.
- Shunt options include syringo-subarachnoid (draining fluid to subarachnoid space) or shunt to pleural/peritoneal cavity.
- Shunts may fail over time due to re-scarring of the arachnoid.
Syringo-Subarachnoid Shunt Procedure
- Procedure involves laminectomy (removal of part of vertebral bone) and opening dura mater.
- Spinal cord is opened and a small silastic (silicone) tube or T-shaped tube is inserted into the syrinx cavity.
- The shunt allows fluid from the syrinx to exit into the subarachnoid space.
- Long-term success is limited; shunts often scar down and symptoms recur.
Key Terms & Definitions
- Syringomyelia — A cystic cavity (syrinx) within the spinal cord, often after injury, causing neurological symptoms.
- Dissociated Sensory Loss — Loss of pain and temperature sensation, but preserved light touch due to dorsal column sparing.
- Dorsal Columns — Part of the spinal cord responsible for fine touch and proprioception.
- Lateral Corticospinal Tract — Spinal cord tract responsible for voluntary motor control.
- Hyperhidrosis — Excessive sweating.
- Autonomic Dysreflexia — Dangerous increase in blood pressure due to autonomic system over-reactivity.
- Horner’s Syndrome — Triad of ptosis (drooping eyelid), miosis (constricted pupil), and anhidrosis (lack of sweating).
- Laminectomy — Surgical removal of the vertebral bone to access the spinal cord.
Action Items / Next Steps
- Review the procedure and indications for syringo-subarachnoid shunting.
- Study the sensory and motor pathways of the spinal cord relevant to syringomyelia.
- Prepare for discussion on surgical risk-benefit analysis in spinal cord injury complications.