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Scoliosis Poor Prognostic Sign in Syringomyelia

In this study adult patients with syringomyelia and scoliosis (curvature of the spine) were compared to patients with syringomyelia without scoliosis.

Syringomyelia is a general term used to describe a cyst or tube-shaped cavity that forms within the spinal cord. There is an abnormal collection of fluid within the spinal cord. The cyst or cavity, called a syrinx expands and gets longer. Sometimes it extends over several spinal levels.

Obstruction to the normal movement of cerebrospinal fluid causes it to flow into the spinal cord instead of around it. The syrinx forms and the cerebrospinal fluid collects in these cysts. Over time, this syringomyelia can destroy the center of the spinal cord.

In this study adults with syringomyelia were divided into two groups. The first group had syringomyelia and scoliosis associated with Chiari malformation type I (CM-I). CM-I describes a protrusion of the cerebellum in the back of the head. The cerebellum is a separate, smaller part of the brain located at the base of the skull just above the cervical spine. With CM-I, the cerebellum slides down into the spinal canal. These patients develop syrinx in the cervical spine.

The second group of patients had syringomyelia with CM-I but without scoliosis.
All patients had surgery to take pressure off the cerebellum to correct the problem. The operation is called a foramen magnum decompression procedure.

Using various measurements before and after the operation, the authors found that scoliosis was a predictor of poor results. The patients with syringomyelia and scoliosis had worse neurologic symptoms. They were more likely to have muscle wasting and weakness in their arms. The syrinx spanned a longer length of the spine. The longer they had the two conditions, the worse the prognosis.

The authors suggest that the scoliosis developed as a result of trunk muscle weakness. Patients with longer syrinx spanning more vertebral bodies are at greater risk for scoliosis. Results of surgery are less favorable for those patients with syringomyelia and scoliosis.

Atsushi Ono, MD, et al. Surgical Outcomes in Adult Patients with Syringomyelia Associated with Chiari Malformation Type I: The Relationship Between Scoliosis and Neurological Findings. In Journal of Neurosurgery: Spine. March 2007. Vol. 6. No. 3. Pp. 216-221.


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