Syringomyelia is a rare neurogenic disease which can damage the spinal cord due to

formation of a fluid-filled area in the form of a cyst (Syrinx), usually found in the
high cervical spine. (Also found in lumbar area but this is very rare)
The name derives from the word Syrinx, greek for a tube-formed object and the
Myelum, referring to the spinal cord.
TYPES OF SYRINGOMYELIA:

Syringomyelia due to blockage of CSF circulation (without fourth ventricular

communication)
Basal arachnoiditis (postinfectious, inflammatory, postirradiation, blood in
subarachnoid space)
Basilar impression or invagination
Meningeal carcinomatosis
Pathological masses (arachnoid cysts, rheumatoid arthritis pannus, occipital
encephalocele, tumors)
Syringomyelia due to spinal cord injury
Fewer than 10% of syringomyelia cases are of this type. Mechanisms of injury include:
spinal trauma
radiation necrosis
hemorrhage from aneurysm rupture or arteriovenous malformation or in a tumour
bed
infection (spinal abscess, human immunodeficiency virus, transverse myelitis)
cavitation following ischaemic injury or degenerative disease
CLINICAL PRESENTATION
The damage to the spinal cord as seen in patients suffering from
Syringomyelia is caused by a Syrinx. This is comparable to a cyst,
a cavity filling with a fluid identical of similar to cerebrospinal
fluid and extracellular fluid, which slowly expands, putting
pressure on the spinal cord and thus damaging it. Such a Syrinx
may be a result of a spinal cord trauma, pressing spinal cord
tumors, inflammation or birth-related defects
Gradual muscle atrophy (especially scapular and cervical neck muscles)
Muscle function loss and muscle weakness
Decreased reflexes in the arm
Persistent headaches
Decreased sensation and sensitivity or even numbness
Radiating pain through the neck, shoulder, upper arms and upper trunk (also ventral)
Uncoordinated movements, spasms and involuntary muscle contractions
Dizziness
Nystagmus (Jerky eye movements)
Facial sensory impairment on one or both sides of the face
SENSORY

Dissociated sensory loss: Syrinx interrupts the decussating spinothalamic fibers that
mediate pain and temperature sensibility, resulting in loss of these sensations,
while light touch, vibration, and position senses are preserved.
When the cavity enlarges to involve the posterior columns, position and vibration
senses in the feet are lost; astereognosis may be noted in the hands.
Pain and temperature sensation may be impaired in either or both arms, or in a
shawl-like distribution across the shoulders and upper torso anteriorly and
posteriorly.
Dysesthetic pain, a common complaint in syringomyelia, usually involves the neck
and shoulders, but may follow a radicular distribution in the arms or trunk. The
discomfort, which is sometimes experienced early in the course of the disease,
generally is deep and aching and can be severe.
MOTOR

Syrinx extension into the anterior horns of the spinal cord damages motor neurons
(lower motor neuron) and causes diffuse muscle atrophy that begins in the hands
and progresses proximally to include the forearms and shoulder girdles.
Clawhand may develop.
Respiratory insufficiency, which usually is related to changes in position, may
occur.
AUTONOMIC

Impaired bowel and bladder functions usually occur as a late manifestation.

Sexual dysfunction may develop in long-standing cases.
Horner syndrome may appear, reflecting damage to the sympathetic neurons in
the intermediolateral cell column.
PHYSICAL THERAPY MANAGEMENT

The physical therapy for patients suffering from Syringomyelia differs depending on
the location and impact of the disease, unless presented with an MRI, a
neurological examination should clear out at which level the syrinx occurs. The
goals of the treatment are to stop the spinal cord damage from getting worse
using the techniques explained in the following paragraph and to maximize
functioning. They may require active physical therapy, passive mobilizations,
occupational therapy or even speech therapy.
RoM
Muscle strength
Neck Stability
Balance,
Coping
Increasing their muscle strength (Usually upper extremity and paravertebral muscles,
using training schemes individualized to the patients’ tolerance)
Training neck stability (best guided by physiotherapist at first)
Sitting and standing balance can be physical and occupational therapy (referring to
daily activities as in getting dressed and grooming)
Educating the patients about their disease and it’s process over time. It is important
to maintain an active lifestyle but there are several risks in high impact activities
which should not be overlooked. (See topic “patient advice during follow up after
surgery) They should also learn aboute adequate pain management and coping
techniques
Improving and/or maintaining communication using speech therapy (when
the syrinx is present in the lower brain stem, although that should be
referred to as ‘syringobulbia’)

Maximizing functional capabilities by testing and asking the patient about

daily activities and then acting upon the answers. This includes activities
such as getting in and out of bed, walking, using a cane of crutches and
such. Physical therapists may also refer a patient to the use of leg
braces if they are deemed appropriate