What is Posttraumatic Syringomyelia (Spine Swelling after Injury)?
Posttraumatic syringomyelia, or PTS, is a condition where a fluid-filled cavity or hole forms in the spinal cord after a traumatic event. This condition can occur even if there wasn’t a noticeable injury to the spinal cord during the trauma. PTS is different from syringomyelia caused by birth defects, which typically occur due to disruptions in the normal flow of spinal fluid. The medical literature may also refer to this condition as cystic myelomalacia or spinal cord cysts. Treating PTS can be challenging because it often leads to a slow but severe loss of feeling and/or muscle control, which can dramatically impact a person’s life. Many patients also experience chronic pain that can disrupt their daily routines and mental wellbeing.
What Causes Posttraumatic Syringomyelia (Spine Swelling after Injury)?
Spinal cord syrinx, a fluid-filled cavity in the spinal cord, is thought to be caused by an obstruction in the natural flow of spinal fluid. This blockage can result from various reasons such as breakages in the vertebrae, scar tissue, adhesions in the delicate membrane covering the spinal cord, physical injuries, deformities in the spine due to injury and scarring in the absence of clear trauma.
Factors like a narrow spinal canal or a deformity in the spine, such as a hunched back, are known to increase the chances of developing a spinal cord syrinx. Additionally, products found in blood may also be a contributing factor.
Risk Factors and Frequency for Posttraumatic Syringomyelia (Spine Swelling after Injury)
Post-traumatic syringomyelia (PTS) doesn’t discriminate based on race or ethnicity. However, it’s more common in males because they have a higher chance of getting into motor vehicle accidents and participating in extreme activities, which often lead to spinal trauma. Out of all people who experience a spinal cord injury, between 1 to 7% will develop symptomatic syringomyelia, which is a complication involving a fluid-filled cavity in the spinal cord.
As modern imaging technologies have become more widespread, doctors are able to identify more cases of PTS. And because people with spinal cord injuries live longer today, the incidence of PTS has gone up. Please note that this condition can develop at any point after the spinal cord injury. In some cases, symptoms can appear as early as one month or as late as 45 years after the injury, with the most common timing being 9 to 15 years post-injury.
- PTS is seen more often following spinal cord injuries in the mid-back (thoracic) rather than the neck (cervical).
- The older the person or the more complete the spinal cord injury, the higher the chance of developing PTS.
Signs and Symptoms of Posttraumatic Syringomyelia (Spine Swelling after Injury)
Typically, it takes around 9 to 15 years from the time of injury to the diagnosis of this particular condition. The main symptom is pain, which might either be confined to the injury area or spread across below the injury level. The pain is usually felt as a burning, aching, or stabbing sensation and may also be sensitive to light touch or pressure. Some people notice that the level of pain increases when they sit up, lie down, sneeze, or cough.
In some cases, there might be an area of tenderness that feels similar to a bruise, even though there’s no visible bruising. Some patients may experience a change in some of their usual bodily functions, such as losing a reflex that helps in urinating, having a bowel movement, or getting an erection.
A close look at the nervous system may further reveal symptoms. These can include increased numbness, weakness, changes in muscle tension or spasticity, or fluctuating heart rate and blood pressure. Loss of pain and temperature sensation while maintaining the ability to perceive touch and pressure is a key indicator. It is often referred to as “sensory dissociation”. Motor weakness, which is reduced muscle strength, may be observed early, but is often found late. Some patients may still be able to move despite having very large syrinx cavities. Muscle stretch reflexes that were previously present may be lost.
Testing for Posttraumatic Syringomyelia (Spine Swelling after Injury)
If someone might have Post-traumatic syringomyelia (PTS), doctors often start by using an imaging test called an MRI (Magnetic Resonance Imaging) for diagnosis. It’s essential to know that the size of the cavity (void or hole) typically found in the spine in this condition doesn’t always match the severity of the symptoms. These cavities are usually found where there has been a spinal fracture or abnormal bending.
However, for those who can’t have an MRI, doctors may use a specialized CT (Computed Tomography) scan called myelography. This type of scan can highlight any blockages to dye flow caused by cord tethering or dural adhesions, which are complications that can arise from PTS.
Doctors may use traditional X-rays, which include flexion-extension views, to spot any signs of spinal instability, kyphosis (a forward rounding of the back), fractures, and dislocations.
Electromyography can be used to track various abnormal spontaneous activities associated with PTS. However, these findings are not specific and this diagnostic tool is mainly used to rule out other conditions that might cause similar symptoms.
Motor evoked potentials, a method used to measure the electrical signals of motor pathways, can be useful for monitoring the prolonged central motor conduction time (slow passage of motor signals), especially during operations. This technology, however, isn’t widely available. After the initial diagnosis, doctors often use MRIs to monitor the patient’s progress and evaluate the effectiveness of surgical treatments.
Treatment Options for Posttraumatic Syringomyelia (Spine Swelling after Injury)
Syringomyelia, a condition characterized by a fluid-filled cavity, or cyst, in the spinal cord, can be challenging to treat. Symptoms and disability caused by these cavities are typically addressed surgically. While some believe that a more conservative approach can be taken due to infrequent or late motor loss, most support early surgery to prevent further complications. Non-surgical treatment could potentially lead to worsening neurological symptoms in up to 68% of patients within a year.
There are different types of surgeries performed to treat syringomyelia. Initial attempts often involve inserting a shunt, a device that can move fluid from the cyst to another part of the body. However, these shunts can sometimes get blocked and may need to be replaced. They can also lead to high rates of complications, including the cyst coming back. Other less common procedures include draining the cyst with a needle, making an incision in the spinal cord, or opening the cord.
More recent surgical treatments focus on restoring the normal flow of spinal fluid, which could be hindered by scar tissue, adhesions, or the spinal cord being abnormally tethered. Procedures like removing a section of the vertebra (laminectomy), taking away adhesions, and widening the spinal fluid space using a surgical method called duraplasty can all be employed.
However, these surgical methods need to be performed with caution in order to avoid damaging the front part of the spinal cord. In cases where the problem is in the higher part of the neck or there’s extensive scar tissue over many levels, this surgical approach may not be possible. It’s important to note that these treatments don’t always prevent the cyst from recurring.
In terms of outcomes, there seems to be disagreement among experts. Some find that changes in cyst size don’t relate with how well the patient does after treatment, while others disagree.
New treatment methods are being explored, including injecting cells derived from the patient’s own bone marrow into the cyst, specifically in cases resulting from trauma.
Monitoring patients with syringomyelia is critical. This can include regular neurological exams, using handheld devices to assess muscle strength, and noting any changes in daily activities like moving about, transferring between seats, or wheelchair use. Particular attention needs to be given to people with a cyst in the neck region, as this can affect breathing. Professionals from different fields of medicine, including rehab teams, can help plan changes in mobility devices, seated/walking activity, and daily living activities. They can also help reduce the risk of complications like sores due to prolonged pressure, decline in mobility, and falls.
What else can Posttraumatic Syringomyelia (Spine Swelling after Injury) be?
If your doctor suspects there might be an issue with your spine, they might mention the following conditions:
- Spinal instability – This is where the spine moves more than it should, making it less able to maintain its proper structure.
- Tethered spinal cord – This is a condition in which the spinal cord is stuck to the tissues around the spine, often leading to problems with movement and development.
- Spinal hematoma – This essentially means there’s a clot of blood near the spine. It can cause serious problems if not addressed quickly.
- Glial scar formation with mass effect – This occurs when there’s a growth or a lump caused by an overgrowth of cells in the brain or spinal cord.
- Subacute progressive ascending myelopathy – This is a condition where the spinal cord doesn’t function as it should, which tends to worsen over time. The person may notice that their symptoms get worse as the condition spreads upwards in the spinal cord.
- Apoptosis of spinal tissue – Apoptosis is a type of cell death, and in this case, it’s affecting the tissue in the spine. This can result in parts of the spine not performing their usual functions.
These spine-related conditions can be serious, so if you are experiencing any persistent back or neck pain, contact your healthcare professional for further testing and treatment options.
What to expect with Posttraumatic Syringomyelia (Spine Swelling after Injury)
Generally, patients who don’t seek treatment and already have health issues may experience worsening neurological conditions within a year. But for those without symptoms or those with minor symptoms who have small cysts, immediate surgery isn’t usually necessary.
Patients with symptoms who do get surgery typically see improvement with radicular symptoms, which are pain symptoms that travel along a nerve. But, the results are not as promising when it comes to autonomic symptoms or muscle stiffness and spasms (spasticity). Fortunately, symptoms usually stop or improve in about 90% of these patients after surgery.
Possible Complications When Diagnosed with Posttraumatic Syringomyelia (Spine Swelling after Injury)
There are numerous signs and symptoms that an individual may exhibit, these can include:
- Gradual numbness
- Progressive weakness
- Increased muscle stiffness
- Excessive sweating or hyperhidrosis
- Instability in blood pressure
- Conditions like postural hypotension, which is a type of low blood pressure that happens when you stand up from sitting or lying down
- Pressure sores
- Reduced mobility
- Falls
- Neuropathic joint disease (Charcot’s joint)
- Burns to areas lacking in sensation
- Progressive abnormal curvature of spine or scoliosis
- Loss of control over bowel and bladder
- If surgery is performed, sensory-motor decay can occur
- Emotional instability
Preventing Posttraumatic Syringomyelia (Spine Swelling after Injury)
People who have had a severe spinal cord injury usually experience both emotional and physical difficulties. The development of a condition called syringomyelia can lead to additional problems. However, it’s important for these individuals to know that syringomyelia can be treated effectively, and most patients suffering from pain due to this condition have positive outcomes. To alleviate discomfort and improve movement, patients might need to go through an intensive rehabilitation period, particularly for symptoms related to muscle tightness and spasms.
