Spinal syrinx sciatica can result from hydromyelia or syringomyelia conditions virtually anywhere in the spinal cord. Being diagnosed with a spinal syrinx is a very serious matter, since these hollows within the substance of the spinal cord can undermine the tissue’s ability to function correctly. Spinal syrinx are some of the most difficult to treat of all back and neck pain conditions, being that they exist within neurological tissue that is extremely delicate and sensitive to any type of intervention. In essence, treatment often makes the condition worse, rather than improving the quality of the patient’s life.
This focused essay explores the presentation of sciatica in association with demonstration of a spinal syrinx or hydromyelia diagnosis. We will explain what a syrinx is, as well as how they can create sciatica symptoms.
We write about sciatica in vivid detail throughout this website, but will summarize its definition here to clarify the diagnosis for patients who are just beginning their research on the topic. Sciatica is defined as neurological pain and other symptoms, such as numbness, weakness and paresthesia in the buttocks, legs and/or feet that is directly caused by compression of one or more of the lumbar or sacral nerve roots that eventually join to form the sciatic nerve. Pseudo-sciatica describes identical symptomatic expressions that are not caused by compression of the lumbar or sacral nerve roots that form the sciatic nerve. There are many, many types of pseudo-sciatica and this diversity is one of the major challenges of achieving an accurate diagnosis of the underlying symptomatic mechanism.
A spinal syrinx is a fluid-filled cavity or cyst that forms inside the center hollow of the spinal cord. The name of the condition is syringomyelia, meaning damage to the spinal cord caused by a syrinx. In true syringomyelia conditions, there is no protection for the neurological tissues that are exposed to the expansion of this hollow space, while in hydromyelia conditions, there remains some protective lining between the nerve cells and the expansion of the hollow tube. Spinal cord tissues are extremely delicate and when they are stressed by the expansion of this interior space inside the cord, cells can fall into dysfunction or even die, eliciting dire motor, sensory and autonomic deficits throughout parts of the anatomy. One possible consequence of a spinal syrinx is the development of sciatica.
A spinal syrinx can not form in the area of the spine that would involve true sciatica, since the roots of L4, L5, S1, S2 and S3 have already separated off into the cauda equina. Remember, the spinal cord usually ends around the L1/L2 levels of the vertebral column. Therefore, when a syrinx is responsible for creating sciatic nerve issues, the condition should rightly be called pseudo-sciatica, since the root causation does not come from compression of the formative nerve tissues, but instead originates from cellular tissue tracts within the spinal cord at higher vertebral levels.
All the nerve roots that branch off the spinal cord, including those from L4 to S3 that eventually join together to create the sciatic nerve, begin as tracts of spinal cord tissue in higher regions of the anatomy. If these tracts are damaged before they form into individual nerve roots, then they might not provide proper functionality to the neurological tissues lower in the body. Basically, although the nerve roots that form the sciatic nerve are not directly present in the neck or middle back, the tracts of nerve cells that deliver messages to those roots are present. If these tracts are injured, then neurological messages will not reach the lower lumbar and sacral nerve roots properly or at all.
When fluid or cyst material forms inside the normally thin hollow tube of the spinal cord, the canal expands, placing pressure on the cells that form the walls of this interior anatomical space within the cord. The pressure applied is usually in direct proportion to the size of the syrinx, defined by the amount of fluid or cyst material contained within the cord. The more force that is exerted within the central cord, the worse its effects will typically be. Likewise, the more force is exerted by the syringomyelia or hydromyelia, the more spinal cord tissue will be affected by compression-type injury.
Picture a hollow tube running through any solid material. If fluid or some type of material accumulates within the tube under pressure, then its increase in mass will push outwards, damaging the surrounding container from within. Unfortunately, in this case, the surrounding container of the syrinx is the spinal cord itself and we all know just how sensitive and virtually irreparable the central nervous system components truly are. When damage is done to the spinal cord, effects might be widespread, diverse and permanent.
Syringomyelia and hydromyelia, to a lesser degree, have the potential to cause extreme trauma to the spinal cord, although it must be made clear that these conditions are not inherently symptomatic in all patients. Size, location and other factors are all important in determining the clinical severity of a spinal syrinx. Some patients will not demonstrate any symptoms, while others might suffer dramatic, disabling and possibly fatal expressions.
When sciatica is caused by a spinal syrinx, symptoms may range greatly. Pain in the legs is common, with a dull, achy feeling being most prevalent. Some patients complain of numbness in the buttocks, saddle region, legs and/or feet, and many also suffer muscular weakness in the same affected regions. Neurological deficits are also commonly experienced, with foot drop, sexual dysfunction and incontinence all being possible consequences of a syrinx. Typically, in sciatica that is related to a syrinx, the symptoms will be more patterned and predictable than in other types of sciatica conditions.
Treatment of spinal syrinx formation is usually symptomatic in nature, revolving around physical therapy and pharmaceutical interventions. There are surgical procedures that can be used to treat a spinal syrinx, but these are fraught with high degrees of risk and many patients suffer recurrences of their syrinx even after the most successful operations. Most neurologists agree that a syrinx should only be treated surgically in matters of true emergency, such as to save life or preserve particularly important aspects of neurological functionality.
Occasionally, a spinal syrinx will resolve all by itself, which is obviously the best case scenario. In other cases, the syrinx might be caused by some other structural defect in the spinal anatomy that can sometimes be surgically treated and rectified. In order to determine the best course of action for any particular syrinx, we strongly suggest seeking care from an expert in the field, such as a neurosurgeon who focuses on syrinx monitoring and therapy.