Last update: 25/09/2018, Dr. Miguel B. Royo Salvador, Medical Board number 10389. Neurosurgeon y Neurologist.
The spinal cord is an organ of the nervous system that runs within the spine and goes from the hole of the skull (foremen magnum), which communicates with the backbone, to the L1 vertebra. Along the whole way of the spinal cord, from the base of the head to the end of the spine in the coccyx, the motor and sensory nerves are originated. The constitution of the spinal cord is the same as that of the brain. There is a central butterfly-shaped grey matter wrapped predominantly with nerve cells and white matter, with a predominance of nerve fibers. When a cavity appears in form of a cyst in the spinal cord, it affects majorly the grey matter and is called syringomyelia. This central hole gives an appearance to the spinal cord that is similar to a flute, or syrinx in Greek. In most cases the cause of its formation is unknown.
Fig 1. – A 26 years old young man, reported lack of thermal sensitivity, especially evident while having showers, in the left half of the head and body for a year. After the sectioning of the filum terminale procedure, he regained his tactile sensitivity in the immediate postoperative period, and five years later, he is virtually asymptomatic.
Syringomyelia symptoms: The patient has alterations in the sense of touch in some parts of the body especially in the arms, in the way that the patient notices the touch but not the object’s temperature, therefore burns easily without pain. The patient loses muscular mass, which leads to the reduction of strength. Alterations in the walking pace can lead to disablement.
The causes of some types of Syringomyelias are known like in the case of a trauma, tumor, infection, spinal cord being held tightly in the lumbar region of the vertebral column due to a congenital diseases such as spina bifida, myelomeningocele and meningocele. However, in most of the cases the cause is unknown, as none of the above mentioned cause is detected.
The Syringomyelia classified as of idiopathic origin or of unknown cause is attributed to the disruption of the CSF or a small posterior fossa by some authors. There are alterations in the circulation but it is of such a little magnitude that it cannot explain the significant damage that appears. As for the portion of the skull that contains the cerebellum, there are studies, which do not find any difference in size of the skull in the patients with Syringomyelia and normal persons.
There are clear arguments that the syringomyelia is due to the dead cells in the center of the spinal cord resulted from the lack of blood flow when the spinal cord is stretched. The tractive force is transmitted by the filum terminale and its insertion to the coccigeal ligament. Both of these organs don’t have any function in an adult.
It has been shown with studies on animals that the slightest traction of the spinal cord makes their neurons stop functioning due to the lack of proper blood flow.
In humans, when this traction force is intense it decreases blood flow at the center of the spinal cord, especially at the cervical region at the top slip. In this zone, the important arteries for the spinal cord are located and they have special centripetal distribution, i.e. they go from the outside to the inside. The lack of blow flow causes the necrosis or the death of part of the spinal cord tissue, which at the same time attracts interstitial fluid from within the spine and forms a cyst in the center of the spinal cord called Syringomyelia; a disease described 500 years ago and was of unknown cause up to present.
Certainly, the simple sectioning of the ligament eliminates the tractive force to which the spinal cord is subdued and improves the blood flow and stops the progression of the disease.
Most of the symptoms are due to the irreversible lesions caused to the nerve tissue, which we know is not able to regenerate itself. Although the nerve tissue can substitute the lost circuits and there are some existing cells or connections that just stopped working and didn’t die under the influence of traction force. When the blood flow is recovered, they can then be restored, improving a few symptoms. The sooner the spinal cord stops suffering the better will be the prognosis.
The surgical sectioning of the filum terminale consists of making a small opening at the sacrum bone, at the end of the spine, without involving any inconveniences that could alter the mechanics of the spine. The Filum terminale ligament is exposed and sectioned with microsurgical techniques, all in just half an hour and it has the added bonus of required hospitalization of less than a day.
The filum terminale, is the result of an empty cover of the spinal cord found at the lower end of the back or lumbosacral region. In the human embryo, the vertebral column and the spinal cord inside have the same length and are separated by some membranas named dura mater, arachnoid and piamater. With the individual’s normal growth, the vertebral column grows about 20 cm more than the spinal cord. The layers that separate the spinal cord from the vertebral column in the lower back region do not contain spinal cord anymore and fold in the form of fibrous cord which is the filum terminale. This sliding of the spinal cord could be compared to a sock we are wearing it and we pull it out half way off our foot, the half that does not contain the foot could be cut at any point with no harm to the foot. In the same way, the filum terminale can be cut along its way without suffering any consequences. (1, 2).
The strain of the filum terminale besides causing Syringomyelia has a bending effect on the vertebral column, which causes Scoliosis. In order to prevent the strain of the spinal cord, the inferior part of the brain named cerebellar tonsils descend through the occipital hole which communicates the skull with the vertebral column causing the Arnold-Chiari Syndrome, a disease described 100 years ago and was of unknown cause up to present.
Syringomyelia is stopped with the sectioning of the filum terminale, the result of a cyst from death of cell stays the same but it can disappear when the space opens spontaneously around the spinal cord or it does it towards the center of it where the ependymal conduct is found that communicates the center of the spinal cord with the marrow cavities in the brain. The symptoms in this illness are produced from the death of cells and the tumor effect of the cyst. The sectioning of the filum terminale has two beneficial effects: it stop the death of the cells under the cord traction and decreases the tumor effect of the cyst while relaxing the spinal cord.
Patients suffering from idiopathic Syringomyelia or associated with idiopathic Scoliosis and/or Arnold Chiari I Syndrome have been operated . The evolution of the disease has been stopped and the patients have noted improvements, in some cases in a spectacular manner.
You can find patients cases in the ICSEB Patients’ testimonials.
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