I have a particular interest in syringiomyelia & arnold chiari malformation as my darling wife, Charlotte has this condition. Those of you who know her will after reading this understand why she has that lovely deep husky voice - it wasn't always that way!
Syringiomyelia refers to the formation of a cyst (or syrinx) in the spinal cord, this cyst can cause damage to the spinal cord & give a variety of symptoms ranging from weakness to paralysis of muscles & from mild loss of sensation to loss of the ability to speak.
2 main causes, one is when you are born with the problem, this is called Arnold-Chiari malformation. It can lie dormant & be triggered by a relatively minor accident. The second cause is when the syrinx is caused by a major trauma such as a car accident or a major illness such as Meningitis.
There are 4 types of this Types I & II are when the back part of the brain 'the cerebellum' pushes down into the 'neck portion' of the spinal canal. Types III & IV are often incompatible with life & will be diagnosed shortly after birth
It can present as headaches & neck pain, weakness in the upper limbs & loss of sensation, it can also present as a hoarse voice or loss of voice due to paralyis of the vocal cords. Often there is 'cloak distribution' loss of sensation where the outside of the shoulder & arm has loss of sensation but the inside of the arm is preserved.
Via MRI & occasionally also electromyography is used to test muscle weakness. Often diagnosis is initially missed as symptoms such as headaches, nausea & neck pain can be common after an accident. It is important that an MRI is taken as soon as possible if syringiomyelia is suspected as delay can lead to permanent disability (See case study below).
Surgery is often but not always required. It you have been diagnosed with syringiomyelia it is essential that you follow up with a neurosurgeon who is experienced in treating this condition. Surgery, especially for arnold Chiari Malformation can consist of a hind brain decompression, i.e. removing a small part of the occiput bone & the back part of the C1 vertabrae. Often it is also recomended to have a shunt inserted, this is a small tube that allows cerebral spinal fluid to bypass the syrinx which will over time allow the syrinx to shrink & prevents further damage at that area of the spinal cord. Post surgical treatment is often overlooked, not only in this condition but many others. Gentle 'cranial' osteopathy can provide excellent results in alleviating post surgical pain & can also help ease restriction in movement caused by the trauma of surgery
12 years before I met my wife Charlotte, she was a 20 year old living in Palmerston North, New Zealand (punishment in itself she tells me) She had a minor car accident & over the next few weeks she started getting headaches that became stronger & she developed nausea. Pain killers wouldn't even dent the headaches. Her doctor thought she had whiplash, & in fairness to him this was in 1994 when MRI's weren't really available & there had only ever been 1 other case of syringiomyelia in NZ before this. The headaches became very severe & she started to lose sensation in her left arm, back to the doctor & he refered to a specialist, whilst waiting to see him she began to lose her voice & more sensation in her arm & the headaches became so bad that she would vomit from the pain levels. Additionally her left side of the face began to droop. The neurosurgeon refered for MRI & it confirmed Arnold Chiari Malformation & a syrinx that reached from the skull down to T10 (that's about two thirds of the way down the back). Surgery was essential & she had a hind brain decompression, with removal of part of the occiput & the back part of the C1 vertabrae. The surgeon offered/recomended a shunt but Charlotte turned this down as this was a new procedure & she would have been numero uno to recieve this in NZ. The surgery was successful, although hearing Charlotte describe the pain in the back of the skull when she awoke from surgery is sobering indeed. Unfortunately as there was a delay in her receiving the surgery she is left with permanent loss of sensation in her left arm & she can't feel any pain or temperature in her left hand (as a trained chef she has decided that this is a bonus!), she also lost the use of her left vocal cord. With speech therapy she was able to strengthen her right vocal cord, she can now speak fine, although she has a permanent husky voice. definitely unique in a Barry White kind of way, & the voice will weaken if she needs to speak for a long period.
13 years later Charlotte has given birth to our 2 children & other than her voice & a slight drop of the right eyebrow her condition isn't noticeable. She has a lot of 'cranial' osteopathic treatment by Ben Evans in Whangarei & by myself & I definitely think this has helped her condition. Having said that without the surgery there would have been no condition & no Charlotte to treat! Osteopathic treatment was a combination of structural & cranial. CV4 always elicited a good response, however as the syrinx extended to T10 it was also vital to ensure optimal spinal mechanics. Treatment of the sacrum, cranially & with the use of MET allowed free movement of that area & minimised the effect of any drag on the dura. Treatment of the lumbars was via functional & BLT. Treatment of the anterior longitudinal ligament as well as the whole dura was also important as there is little movement of C2 due to the scar tissue in that area, which is thick & extends from C2 up into the area of the occiput that has been removed. Palpation of that area is rather unusual given that the posterior arch of C1 has also been removed. This treatment protocol also works well for patients who have had other conditions that have required brain surgery and/or shunts. Often I have seen osteopaths shy away from treating such patients as they feel that this is area that would only benefit from cranial. However, in all these cases there can be huge benefit derived from optimal spinal mechanics & without this there can be a strong detrimental influence caused by a straight forward mechanical drag on the spinal cord & brain stem. As such a skilled application of structural and/or functional techniques can be very effective. The key as always is treat osteopathically & not to focus on the obvious area of complaint!
We both researched this thoroughly & the medical research at the time of Charlotte's 1st pregnancy was that 'pushing' was not reccomended as it would increase the intra-thecal pressure within the spinal cord. As a consequence our 1st child was born with the aid of a vontoose (vaccuum extraction) & episiotomy. On hindsight I think Charlotte could have had a natural delivery & it would have been fine, but who knows. Our 2nd child born 3 years later was a natural delivery without any medical assistance. Both pregancies & births have not affected Charlotte's syringiomyelia. This was confirmed by MRI, & the last MRI taken showed that the syrinx had actually decreased in size.
Dr Jonathan Evans is a Registered Osteopath who has his practice is in the Gold Coast of Australia