Last year, I had a female patient in her late 20's involved in a MVA. She had severe neck pain. She also had been to another chiropractor (yes, he adjusted her neck). She reported during the history having an episode of transient pain and tingling in her arms and legs subsequent to the MVA. As a result, I ordered a C-Spine MRI. The MRI report stated she developed a hydromyelia. Having a great relationship with the radiologist, she asked if I knew the difference between a syrinx and a hydromyelia (I did not). She explained a hydromyelia is an expansion of the central spinal canal. A syrinx is an expansion anywhere in the spinal cord except the central spinal canal.
In the recent Quickie Consult #499, Dr. Studin discussed what he called a syrinx. Noting it was in the central spinal canal, I called the radiologist to clarify our prior conversation. She stated a hydromyelia is in the central spinal canal. She said in some instances, a syrinx will approximate the central spinal canal and so you can not differentiate which is which. She explained in that instance, a radiologist would call it a syringomyelia. She said there is definitely a difference between a syrinx and a hydromyelia. I asked other than location, what was the pathological difference. She told me that a hydromyelia contains ependymal cells and a syrinx does not.
Recall the ependymal cells are a thin epithelium-like lining of the ventricular system of the brain and spinal cord. They are involved with CSF production.
Having learned this, I called Dr. Studin who asked me to write this up to the group. It is fascinating how a hydromyelia and a syrinx are similar yet based upon location and pathology they are a little bit different. For the record, I spoke with Sheldon Hoxie DC (chiropractic neurologist and current medical school student) about this case a little over a year ago. He said they have advanced neurosurgical procedures to seal off the central canal so as to prevent further expansion. The thing we discussed the most was this. Until corrected or cleared by a neurosurgeon it is best not to adjust them. I say it is best not to because, he did discuss the possibility of adjusting around the area so long as you do not increase Valsalva pressure in the patients cervical spine-which he has done safely.
That said, I feel the best option is to refer to a neurosurgeon. In my discussion, with the neurosurgeon and some other MD's about this, I learned this is not always surgical and some surgeons will not do surgery on it. Knowing this, it is important you get the patient to a neurosurgeon has experience with this since, if it expands, as you are well aware, it could become a very serious issue for the patient.
Also note, the neurosurgeon can order a MRI with contrast to check for increased metabolic activity to determine if the injury is due to trauma. It was advised not to do this as a DC, because once you do that, you are now managing the spinal cord injury on a different level and it could open you up an enormous liability.
Regarding my patient, I do not know her outcome. I referred her to the neurosurgeon and she never returned to my practice.
I hope this helps.
Dr. Matt Erickson
Doctor of Chiropractic
Mark Studin DC, FASBE(C), DAAPM, DAAMLP
Adjunct Assistant Professor of Chiropractic, University of Bridgeport, College of Chiropractic
Adjunct Professor, Division of Clinical Sciences, Texas Chiropractic College
Educational Presenter, Accreditation Council for Continuing Medical Education Joint Partnership with the State University of New York at Buffalo, School of Medicine and Biomedical Sciences
Academy of Chiropractic
US Chiropractic Directory