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Chiropractic Research Review

Understanding Cervical Syringomyelia

Syringomyelia, a potentially debilitating complication of spinal cord trauma, occurs in an estimated 0.3-3.2% of spinal injuries and may appear any time from a few months to several years after injury.

This condition is caused by the formation of a fluid-filled cavity inside the spinal cord.

This educational case study followed a 49-year-old man with cervical pain following an accident in a swimming pool, in which his head had been forced forward with a kick during rough play. His symptoms included worsening pain over the 24 hours since the accident, which radiated to his left arm and hand; loss of motor control in the left thumb; and initial stiffness and headache following the injury. Palpation revealed hypertonicity of the cervical paraspinal musculature, especially on the left side, and tenderness at the articular pillars at mid/low cervical levels. Reflexes, sensory abilities, strength, and range of motion were normal.

The subject was administered HVLA manipulation to the cervical and upper-thoracic levels, which provided some relief. However, after two additional visits, symptoms remained and he was referred for magnetic resonance imaging (MRI), which revealed a syrinx at C6-C7. Referral to a neurosurgeon resulted in a diagnosis of the syringomyelia as benign; the patient continued to see his chiropractor. After several months of chiropractic care, his neck and arm symptoms abated.
Some of the primary features of typical syringomyelia:

* presenting symptoms such as initial pain, radiating pain, and motor weakness and later sensory loss (which in most cases becomes permanent);
* associated conditions include spinal trauma, herniated discs, tumors, scoliosis, and multiple sclerosis; and
* the condition most commonly presents in the cervical spine.

MRI is the best diagnostic tool for syringomyelia, while radiography has low efficacy for locating this condition. The role of manipulation as harmful or helpful is unclear in the literature. Some authors support manipulation of the syrinx area while others state it as a contraindication.
Surgery is recommended for progressive cases, however, a majority of patients show little neurological improvement post-surgery. The author recommends that more chiropractors should be aware of this rare but potentially dangerous condition since they are likely treating patients with syringomyelia on a regular basis.

Flanagan T. Post-traumatic syringomyelia: A case report. Journal of the Neuromusculoskeletal System 2002:10(1), pp. 20-27.

Chiropractic Research Review

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