Post Traumatic Syringomyelia

By Steven J. Angles, Attorney at Law

 In addition to a number of common spinal injuries and neck/back pain symptoms following a trauma, there is a not-so-common and slow-forming medical condition known as post-traumatic syringomyelia (PTS) that effects some people who have suffered a traumatic injury to the spine. Given the slow forming nature of the condition, as well as its similar presentation to other medical complications, diagnosing and treating PTS can be very difficult.

What is Syringomyelia?

Syringomyelia is the condition where a fluid-filled cyst, known as a “syrinx”, grows within the spinal cord.  Over time, the fluid-filled cavity gradually expands and presses on nerves that serve the hands and arms (in the case of syringomyelia affecting the cervical spinal cord) or the lower extremities (when syringomyelia affects the lumbar spinal cord). As a result, pain, lack of nerve sensation, weakness, and loss of muscle bulk (muscular atrophy) typically occur as the syrinx grows.

What causes Syringomyelia?

Post-traumatic syrinxes typically form from the dissolution of pooled blood (a hematoma), the release of certain enzymes and amino acids, and mechanical damage from cord compression.[1] The resulting cyst forms, enlarges, and subsequently fills with cerebrospinal fluid, or CSF (a watery, protective substance which normally flows around the spinal cord and brain, transporting nutrients and waste products.  It also acts as a cushion to protect the brain and spinal cord).   The expansion of the syrinx cyst can occur due to turbulent CSF flow, or a “one-way valve” phenomenon that allows CSF into, but not out of, the cyst cavity.

This redirected CSF accumulates within the tissue of the spinal cord and forms a fluid-filled syrinx.  Pressure differences along the spine can cause the fluid to move within the syrinx and outside the spinal cord.  Physicians believe that this continual movement of fluid in and around the spinal cord results in cyst growth and further damage to the spinal cord tissue.

Diagram by The Reed Group

Diagram by The Reed Group

How is Syringomyelia detected?

Syrinxes are diagnosed by magnetic resonance imaging (MRI), but physicians can often detect the presence of a syrinx by testing a patient’s loss of pin-prick and temperature sensation, both early signs of syringomyelia. Also, strength tests and nerve conduction tests are useful for monitoring syrinx status and assessing the effectiveness of treatments. Nerve conduction tests can also help detect other causes of neurologic decline that may mask or occur simultaneously with a syrinx, such as carpal tunnel syndrome, other peripheral nerve entrapment, or spinal cord impingement.

How is Syringomyelia treated?

Surgery is often used to prevent syrinxes from expanding and the surgeon has a few approaches.  A shunt tube can be placed in the syrinx to drain fluid into the abdominal cavity. Another procedure involves a dural graft, wherein the space around the spinal cord is enlarged to allow free flow of fluid and reduce pressure. A cordectomy involves cutting across the spinal cord and opening up the syrinx to release fluid. All of these surgical procedures have risks and limitations, and none is ideal in patients with incomplete injuries and preserved motor function below the syrinx, because of the risk that the surgery may result in the loss of some or all of this function. Non-operative treatments for syringomyelia usually result in only modest and temporary improvements.

The Importance of Proper Diagnosis

In many cases, syringomyelia is related to a pre-traumatic congenital abnormality of the brain called a Chiari I Malformation.[2]  Patients with PTS frequently find themselves in a difficult position of proving their injuries were caused by the negligence of someone else, as many insurers deny these injuries by pointing to a congenital abnormality.  Thus, the detection and proper diagnosis of PTS is crucial.

As important as it is that an experienced attorney understands the medical issues and the legal precedent in Washington regarding the difference between active and inactive pre-existing conditions, a knowledgeable attorney also plays a crucial role in proving how inactive and asymptomatic conditions, even congenital ones, can be lit up and made symptomatic by trauma.  The attorneys at Adler Giersch are ready, willing and able to handle all types of traumatic injury cases, including those with rare and complicated medical issues and symptoms that insurers typically deny as “pre-existing,” or congenital.  Simply give us a call.

 



[1] Lance Goetz, MD; Posttraumatic Syringomyelia Clinical Presentation, Medscape Reference, January 18, 2012.

[2] “Syringomyelia Fact Sheet,” National Institute of Neurological Disorders and Stroke, NIH Publication No. 10-3780; December 30, 2013.