ANATOMY OF THE SPINE
The human spine is formed by individual vertebrae and connective tissue discs in between. The vertebrae form the spinal canal. There are seven cervical, twelve thoracic, and five lumbar vertebrae. The intervertebral discs are the link between the individual vertebral bodies.
Normal anatomy of the spine. Longitudinal section and cross sections through the cervical, thoracic and lumbar spine.
The little joints that link the vertebrae together are known as facet joints. They help to stabilize the spine and, together with the intervertebral discs, allow a certain degree of mobility of the spinal cord. The spinal canal should be wide enough to allow nerve roots to float freely in cerebrospinal fluid.
The front border of the spinal canal is built by the vertebral bodies and intervertebral discs, the side by the intervertebral joints (facets) and back by the ligamentum flavum (yellow band) and vertebral arches. Discs consist of an outer fibrous ring (annulus fibrosus), which surrounds an inner gel-like center (nucleus pulposus).
The spinal cord and nerve roots lie within the spinal canal. The spinal cord extends downwards approx. to the 1st lumbar vertebra. Below, only nerve roots are present in the spinal canal. At the level of the intervertebral disc the nerve roots pass through the neural root foramina to exit the spinal canal. The spinal cord and nerve roots conduct electric-like signals from the skin and joints to the brain, and process of movement is initiated from the brain to the muscles.
Syringomyelia is a fluid-filled cyst (syrinx) within thе spinal cord. Over time, the cyst may become enlarged and may damage the spinal cord. Syringomyelia occurs most often due to spinal cord compression (e.g. Chiari malformation, tumors, etc), spinal cord injuries and inflammation. In some patients, syringomyelia is a progressive disorder causing pain and paralysis. Others have no associated symptoms.
CAUSE OF SYMPTOMS
Gradually progressing damage to the spinal cord
SYMPTOMS AND SIGNS
Patients usually have no symptoms.
Numbness, weakness, stiffness in the limbs and ataxic gait. Symptoms begin gradually and tend to worsen over months and years.
THE DIAGNOSIS IS BASED ON Medical history Clinical exam Magnetic resonance imaging (MRI)
Treatment is usually non-surgical.
Non-surgical treatment may include Physiotherapy
WHEN SHOULD AN OPERATION BE PERFORMED?
Progression of symptoms
WHAT IS THE GOAL OF SURGERY?
Removing the obstruction of CSF flow
Relieve the pressure that the syrinx puts on the spinal cord
Draining the syrinx
To stop the worsening of the symptoms
To improve symptoms (e.g. pain reduction)
HOW IS SURGERY PERFORMED?
Drainage of syrinx
Spinal cord decompression
WHICH OTHER DISEASES SHOULD BE EXCLUDED (DIFFERENTIAL DIAGNOSIS)? Tumor of the spine
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