Abstract
Purpose
To clarify the clinical manifestation and radiological characteristics of idiopathic syringomyelia (IS) and to investigate the relationship between syrinx and scoliotic curves in IS-related scoliosis patients.
Methods
Fifty-five patients with IS and scoliosis were identified and reviewed retrospectively from June 2009 to December 2016. Radiographic features of syrinx, scoliosis and clinical manifestations of neurological deficits were collected. The syrinx/cord (S/C) ratio was defined as the anteroposterior diameter of syrinx divided by the diameter of spinal cord at the same level. Patients were classified into two groups, the thoracic group (T group, apex vertebra located from T2 to intervertebral disk of T11–T12) and the thoracolumbar/lumbar group (TL/L group, apex vertebra located from T12 to L5).
Results
There was no correlation between the radiological features of idiopathic syrinx and scoliotic curve parameters. The TL/L group had a lower level of most caudal extent (13.7 compared with 10.6, P = 0.029) and lower level of largest S/C ratio (12.0 compared with 8.7, P = 0.016) than that in T group. The deviated side of syrinx was not coincident with major curve convexity (27.2% concordance rate, P = 0.522) or dominant side of neurological deficit (16.3% concordance rate, P = 0.212).
Conclusions
Patients with major curves located on the thoracolumbar or lumbar spine had a much lower caudal extent and lower level of greatest S/C ratio compared to patients with major curves located on the thoracic spine. No significant relationships were detected between syrinx features, scoliotic curve parameters and neurological deficits.
Graphical abstract
These slides can be retrieved under Electronic Supplementary Material.
Similar content being viewed by others
References
Zhang Y, Xie J, Wang Y et al (2018) Intraspinal neural axis abnormalities in severe spinal deformity: a 10-year MRI review. Eur Spine J. https://doi.org/10.1007/s00586-018-5522-3
Roy AK, Slimack NP, Ganju A (2011) Idiopathic syringomyelia: retrospective case series, comprehensive review, and update on management. Neurosurg Focus 31:E15
Feng F, Tan H, Li X et al (2017) Radiographic characteristics in congenital scoliosis associated with split cord malformation: a retrospective study of 266 surgical cases. BMC Musculoskelet Disord 18:420
Shen J, Wang Z, Liu J et al (2013) Abnormalities associated with congenital scoliosis: a retrospective study of 226 Chinese surgical cases. Spine (Phila Pa 1976) 38:814–818
Rodriguez A, Kuhn EN, Somasundaram A et al (2015) Management of idiopathic pediatric syringohydromyelia. J Neurosurg Pediatr 16:452–457
Zhu Z, Sha S, Chu WC et al (2016) Comparison of the scoliosis curve patterns and MRI syrinx cord characteristics of idiopathic syringomyelia versus Chiari I malformation. Eur Spine J 25:517–525
Godzik J, Dardas A, Kelly MP et al (2016) Comparison of spinal deformity in children with Chiari I malformation with and without syringomyelia: matched cohort study. Eur Spine J 25:619–626
Ozerdemoglu RA, Denis F, Transfeldt EE (2003) Scoliosis associated with syringomyelia: clinical and radiologic correlation. Spine (Phila Pa 1976) 28:1410–1417
Batzdorf U, Khoo LT, McArthur DL (2007) Observations on spine deformity and syringomyelia. Neurosurgery 61:370–377
Yeom JS, Lee CK, Park KW et al (2007) Scoliosis associated with syringomyelia: analysis of MRI and curve progression. Eur Spine J 16:1629–1635
Zhang ZX, Feng DX, Li P et al (2015) Surgical treatment of scoliosis associated with syringomyelia with no or minor neurologic symptom. Eur Spine J 24:1555–1559
Sha S, Zhang W, Qiu Y et al (2015) Evolution of syrinx in patients undergoing posterior correction for scoliosis associated with syringomyelia. Eur Spine J 24:955–962
Wu T, Zhu Z, Jiang J et al (2012) Syrinx resolution after posterior fossa decompression in patients with scoliosis secondary to Chiari malformation type I. Eur Spine J 21:1143–1150
Marks M, Petcharaporn M, Betz RR et al (2007) Outcomes of surgical treatment in male versus female adolescent idiopathic scoliosis patients. Spine (Phila Pa 1976) 32:544–549
Sha S, Qiu Y, Sun W et al (2016) Does surgical correction of right thoracic scoliosis in syringomyelia produce outcomes similar to those in adolescent idiopathic scoliosis? J Bone Joint Surg Am 98:295–302
Struck AF, Haughton VM (2009) Idiopathic syringomyelia: phase-contrast MR of cerebrospinal fluid flow dynamics at level of foramen magnum. Radiology 253:184–190
Shah A, Sathe P, Patil M et al (2017) Treatment of “idiopathic” syrinx by atlantoaxial fixation: Report of an experience with nine cases. J Craniovertebr Junction Spine 8:15–21
Struck AF, Carr CM, Shah V et al (2016) Cervical spinal canal narrowing in idiopathic syringomyelia. Neuroradiology 58:771–775
Bateman GA (2015) Pulse wave myelopathy: an update of an hypothesis highlighting the similarities between syringomyelia and normal pressure hydrocephalus. Med Hypotheses 85:958–961
Faloon M, Sahai N, Pierce TP et al (2018) Incidence of neuraxial abnormalities is approximately 8% among patients with adolescent idiopathic scoliosis: a meta-analysis. Clin Orthop Relat Res. https://doi.org/10.1007/s11999.0000000000000196
Zhang W, Sha S, Xu L et al (2016) The prevalence of intraspinal anomalies in infantile and juvenile patients with “presumed idiopathic” scoliosis: a MRI-based analysis of 504 patients. BMC Musculoskelet Disord 17:189
Magge SN, Smyth MD, Governale LS et al (2011) Idiopathic syrinx in the pediatric population: a combined center experience. J Neurosurg Pediatr 7:30–36
Saifuddin A, Tucker S, Taylor BA et al (2005) Prevalence and clinical significance of superficial abdominal reflex abnormalities in idiopathic scoliosis. Eur Spine J 14:849–853
Arnautovic KI, Muzevic D, Splavski B et al (2013) Association of increased body mass index with Chiari malformation Type I and syrinx formation in adults. J Neurosurg 119:1058–1067
Acknowledgements
This study was funded by National Natural Science Foundation of China (Grant Nos. 81330044, 81772424) and National Natural Science Foundation of Beijing (Grant No. 7151006).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
For this type of study formal consent is not required.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Tan, H., Shen, J., Feng, F. et al. Clinical manifestations and radiological characteristics in patients with idiopathic syringomyelia and scoliosis. Eur Spine J 27, 2148–2155 (2018). https://doi.org/10.1007/s00586-018-5679-9
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-018-5679-9