Treatment Options for Cervical Myelopathy and Syringomyelia

Treatment of cervical syringomyelia

I went to New Taipei Hospital for consultation due to tightness and pain in my neck and shoulders.
An MRI on July 27 revealed that the nerve root is being compressed between the C4 and C5 vertebrae, and there is spinal cord compression between the C5 and C6 vertebrae, along with a syrinx at the C6 and C7 levels.
I was referred to Taipei Veterans General Hospital on August 20 for a nerve conduction study, where the doctor said there were no issues and advised me to wait until I can no longer walk before considering surgery.
Subsequently, I consulted with another physician who recommended cervical disc replacement or fusion at the C5 level to alleviate the spinal cord compression and allow for smoother flow of cerebrospinal fluid in the subarachnoid space, thereby reducing pressure at the syrinx and relieving pain.
Additionally, I have scoliosis (with my left shoulder higher than my right shoulder, which the doctor said is not severe).
Currently, I experience significant pain when bending my neck up and down, numbness and tightness in my limbs, dizziness and headaches, poor sleep, and decreased vision.
Since the initial diagnosis, my pain and discomfort have been progressively worsening.

I have the following questions for the physician:
1.
Is this treatment direction feasible?
2.
Are my current pain and symptoms caused by spinal cord compression or the syrinx?
3.
The consulting physician mentioned that my syrinx is not suitable for drainage surgery due to its small size and the potential for significant surgical trauma; is this correct?
4.
Additionally, if I do not undergo this surgery, will the syrinx worsen? (The doctor mentioned that due to spinal cord compression and impaired cerebrospinal fluid flow in the subarachnoid space, it could gradually deteriorate.)

Zhong Xiansheng, 40~49 year old female. Ask Date: 2018/10/26

Dr. Zhao Shaoqing reply Neurosurgery

Spinal cord compression can lead to sensory and motor neurological symptoms, including pain, numbness, and weakness in the neck and both upper limbs.
If there is a presence of syringomyelia, it generally indicates irreversible damage to the spinal cord.
Surgical intervention on the cervical spine is recommended to prevent further deterioration caused by the compression.

Reply Date: 2018/10/26

More Info

Cervical myelopathy and syringomyelia are serious conditions that can significantly impact a person's quality of life. Understanding the treatment options and the implications of your symptoms is crucial for making informed decisions about your health.

1. Treatment Direction: The recommendation for cervical disc replacement or fusion surgery is a common approach for addressing issues related to cervical myelopathy, especially when there is evidence of spinal cord compression. These procedures aim to relieve pressure on the spinal cord and nerve roots, which can help alleviate pain and improve neurological function. The goal is to restore normal alignment and stability to the cervical spine, allowing for better flow of cerebrospinal fluid (CSF) and reducing the risk of further complications. Given your symptoms of pain, numbness, and weakness, pursuing surgical intervention may be a viable option, especially if conservative treatments (like physical therapy or medication) have not provided relief.

2. Symptoms and Causes: The pain and discomfort you are experiencing could be attributed to both spinal cord compression and the presence of a syrinx (the fluid-filled cavity associated with syringomyelia). Compression of the spinal cord can lead to a range of neurological symptoms, including pain, weakness, and sensory changes in the limbs. The syrinx itself can also contribute to these symptoms, as it can disrupt normal spinal cord function. It is essential to have a thorough evaluation to determine the extent to which each factor is contributing to your current condition.

3. Syrinx Management: The decision not to perform a drainage procedure for the syrinx due to its small size and the potential for significant surgical risk is a common clinical judgment. In many cases, if the syrinx is not causing severe symptoms or if the risks of surgery outweigh the benefits, doctors may opt for a conservative approach. Monitoring the syrinx with regular imaging studies can help assess whether it is changing in size or causing new symptoms over time.

4. Potential for Progression: If left untreated, cervical myelopathy and syringomyelia can indeed worsen. The ongoing compression of the spinal cord can lead to progressive neurological deficits, and the syrinx may enlarge, potentially exacerbating symptoms. It is crucial to maintain open communication with your healthcare providers about any changes in your symptoms. If you notice an increase in pain, weakness, or other neurological issues, it may warrant a reevaluation of your treatment plan.

In summary, the treatment options you are considering, including cervical disc replacement or fusion, are appropriate given your symptoms and MRI findings. It is essential to weigh the risks and benefits of surgery, especially in the context of your overall health and the potential for symptom progression. Regular follow-ups with your healthcare team, including neurosurgeons and pain specialists, will be vital in managing your condition effectively. If you have concerns about the progression of your symptoms or the effectiveness of your current treatment plan, do not hesitate to seek a second opinion or further evaluation. Your health and well-being should always be the priority.

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