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Spinal cord cyst surgery

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I have a Thoracic disc herniation, but I also have a searing on my spinal cord. I'm having a CT scan to rule out the possibility that the searings is caused by a cyst and not by the herniation. I am extremely anxious about having surgery on my spinal cord. I have no symptoms as of now. Is the surgery to retrieve a benign cyst from spinal cord extremely dangerous?
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replied June 17th, 2011
Especially eHealthy

Syringomyelia is a generic term referring to a disorder in which a cyst or cavity forms within the spinal cord. This cyst, called a syrinx, can expand and elongate over time. This may result in pain, paralysis, weakness, and stiffness in the back, shoulders, and extremities. Syringomyelia may also cause a loss of the ability to feel extremes of hot or cold, especially in the hands. The disorder generally leads to a cape-like loss of pain and temperature sensation along the back and arms. Each patient experiences a different combination of symptoms. These symptoms typically vary depending on the extent and, often more critically, to the location of the syrinx within the spinal cord. Syringomyelia has a prevalence estimated at 8.4 cases per 100,000 people, with symptoms usually beginning in young adulthood. Signs of the disorder tend to develop slowly, although sudden onset may occur with coughing, straining, or myelopathy.

The precise causes of syringomyelia are still unknown. It has been observed that obstruction of the cerebrospinal fluid pulsation in the subarachnoid space can result in syrinx formation. A number of pathological conditions can cause an obstruction of the normal cerebrospinal fluid pulsation. These include Chiari malformation, spinal arachnoiditis, scoliosis, spinal vertebrae misalignment, spinal tumors, spina bifida, and many others. The reasons that blockage of the cerebrospinal fluid pulsation within the subarachnoid space can result in syrinx formation are, again, still not known. But, once a syrinx has formed, pressure differences along the spine have been proposed to be one mechanism causing fluid movement within the cyst.

In the absence of symptoms, syringomyelia is usually not treated. In addition, a physician may recommend not treating the condition in patients of advanced age or in cases where there is no progression of symptoms. Whether treated or not, many patients will be told to avoid activities that involve straining.

Since the natural history of syringomyelia is poorly understood, a conservative approach may be recommended. When surgery is not yet advised, patients should be carefully monitored by a neurologist or neurosurgeon. Periodic MRI's and physical evaluations should be scheduled at the recommendation of a qualified physician.

Drugs have no curative value as a treatment for syringomyelia. But, for many patients, who have severe chronic pain treatment may involve the use of two or more medications: one, a medication for the “classic” back pain, such as a weak or strong opioid (eg tramadol or oxycodone, respectively); and two, a medication to help with any neuropathic pain symptoms (shooting, stabbing, burning type pains), such as one of the anticonvulsants (eg gabapentin or pregabalin).

Surgery is usually considered the only viable treatment for syringomyelia. But, not all patients will advance to the stage where surgery is needed. Evaluation of the condition is often difficult because syringomyelia can remain static for extended periods of time, whereas in other cases, it may progress rapidly.

Surgery of the spinal cord has certain, characteristic risks associated with it and the benefits of a surgical procedure on the spine have to be weighed against the possible complications associated with any procedure. Surgical treatment is aimed at correcting the condition that allowed the syrinx to form in the first place. It is important to understand that drainage of a syrinx does not necessarily mean the complete elimination of the syrinx-related symptoms, but rather is aimed at stopping its progression.

So, you need to obtain the CT scan, and if necessary an MRI, to delineate exactly how large the syrinx actually is. These studies can usually also determine if any other structures about the spine are compromised. If you are having neurological symptoms, sometimes electrical studies such as an EMG (electromyography) or NCV (nerve conduction velocity) are performed.

It is very important to sit down with your neurosurgeon and discuss the results of all the tests and then, along with taking your symptoms into account, come up with a treatment plan.

Hope you do well. Good luck.
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replied June 17th, 2011

Thank you so very much for your reply! I had the NCV and currently I have no symptoms...the question is wether it is the herniation that is causing the blockage or it is a cyst...that is why I'll be having the CT scan..the MRI shows the herniation just below the area where the spinal cord is blocked...

I agree with you as does my Doctor..if the reason for the blockage is a cyst...then I won't do any surgery, but rather monitor the situation...if, on the other hand it is the herniation that is causing it...then I will have the surgery to correct it. It is my understanding that this surgery is not as risky and it makes sense to correct it and get the pressure off the spinal cord in the hope that the spinal fluid will start flowing again...

I appreciate your help very much!
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