eMedicine Specialties > Neurology > Movement and Neurodegenerative Diseases

Syringomyelia: Follow-up

Author: Hassan Ahmad Hassan Al-Shatoury, MD, PhD, MHPE, Assistant Professor, Department of Neurosurgery, Suez Canal University; Co-Director, Center of Research and Development in Medical Education and Health Services Suez Canal University Hospital
Coauthor(s): Ayman Ali Galhom, MD, PhD, Lecturer (Associated Professor), Department of Neurosurgery, Suez Canal University Faculty of Medicine, Egypt; Franklin C Wagner, Jr, MD, Former Chief, Division of Spine and Spinal Cord Surgery, Former Professor, Department of Neurosurgery, University of Illinois at Chicago College of Medicine
Contributor Information and Disclosures

Updated: Sep 24, 2008

Follow-up

Further Inpatient Care

Generally, patients with uncomplicated syringomyelia who have mild, relatively stable disability may be monitored on an outpatient basis. Patients with severe disability are better served in the hospital.

  • Postoperative care
    • Provide appropriate care of the surgical wound.
    • Check for CSF leakage from tubes exiting the dura.
    • Provide neck collar as needed for patient comfort.
  • Reported postoperative complications include the following:
    • Worsening of neurological deficit
    • Low-pressure headache
    • Shunt infection or obstruction
  • MRI is recommended during the early postoperative period as a baseline for further studies.

Further Outpatient Care

  • Document the following at each return visit:
    • Healing of the surgical incision
    • New neurological deficits
    • Status of the integument, genitourinary, gastrointestinal, vascular, and respiratory systems
    • Nutrition, affect/mood, activities of daily living, overall disability, and employment potential
  • Laboratory studies
    • Appropriate blood work
    • Urinalysis and assessment of renal function
  • Specialty referrals
    • Physical therapy
    • Occupational therapy: An occupational therapist can assist with specific home or work station modifications. Early referral is indicated to minimize further immobility or inactivity.
    • Other referrals: The patient's care should be reviewed by social services, psychologist, recreational therapist, orthopedist, neurologist or neurosurgeon, urologist, or internist, as appropriate.

Inpatient & Outpatient Medications

  • NSAIDs (eg, acetylsalicylic acid, naproxen, ibuprofen, indomethacin, mefenamic acid, piroxicam)
  • Muscle relaxants (eg, cyclobenzaprine, methocarbamol, baclofen)

Complications

Myelopathy is the most serious consequence of syringomyelia. The following are the 7 grade classifications of disability from myelopathy according to the Modified Nurick Classification.

  • Grade 0 - No root signs or symptoms
  • Grade I - Root signs or symptoms; no evidence of cord involvement
  • Grade II - Signs of cord involvement; normal gait
  • Grade III - Mild gait abnormality; able to be employed
  • Grade IV - Gait abnormality prevents employment
  • Grade V - Able to ambulate only with assistance
  • Grade VI - Chairbound or bedridden

Complications due to myelopathy include the following:

  • Recurrent pneumonia
  • Paraplegia or quadriplegia
  • Decubitus ulcers
  • Bowel and urinary dysfunction

Prognosis

  • Prognosis depends on the underlying cause, the magnitude of neurological dysfunction, and the location and extension of the syrinx.
  • Patients presenting with moderate or severe neurological deficits fare much worse than those patients with mild deficits. Patients with central cord syndrome have poor response to treatment.
  • Natural history of syringomyelia still is not well understood. Although older studies had suggested that 20% of patients died at an average age of 47 years, mortality rates are likely lower in today's patients as a result of surgical interventions and better treatment of complications associated with significant paresis, such as pulmonary embolism.

Patient Education

  • Avoid high-impact exercise, such as running and jumping in cases associated with cervical instability.
  • Avoid activities involving Valsalva maneuvers.

Miscellaneous

Medicolegal Pitfalls

  • Overuse of muscle relaxants
  • Overuse of pain medication
  • Prolonged rest or inactivity
  • Vigorous exercise
  • Failure to recognize chronic pain syndrome (See Medscape's Chronic Pain Management Resource Center.)
  • Surgical complication of infection and spinal cord trauma
 


More on Syringomyelia

Overview: Syringomyelia
Differential Diagnoses & Workup: Syringomyelia
Treatment & Medication: Syringomyelia
Follow-up: Syringomyelia
Multimedia: Syringomyelia
References
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References

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Further Reading

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Keywords

syringomyelia, hydromyelia, syrinx, syringohydromyelia, syringocephalus, syringobulbia

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Contributor Information and Disclosures

Author

Hassan Ahmad Hassan Al-Shatoury, MD, PhD, MHPE, Assistant Professor, Department of Neurosurgery, Suez Canal University; Co-Director, Center of Research and Development in Medical Education and Health Services Suez Canal University Hospital
Disclosure: Nothing to disclose.

Coauthor(s)

Ayman Ali Galhom, MD, PhD, Lecturer (Associated Professor), Department of Neurosurgery, Suez Canal University Faculty of Medicine, Egypt
Ayman Ali Galhom, MD, PhD is a member of the following medical societies: Congress of Neurological Surgeons
Disclosure: Nothing to disclose.

Franklin C Wagner, Jr, MD, Former Chief, Division of Spine and Spinal Cord Surgery, Former Professor, Department of Neurosurgery, University of Illinois at Chicago College of Medicine
Franklin C Wagner, Jr, MD is a member of the following medical societies: Alpha Omega Alpha, American Association for the Surgery of Trauma, American Association of Neurological Surgeons, American College of Surgeons, American Medical Association, Sigma Xi, Society for Neuroscience, and Society of Neurological Surgeons
Disclosure: Nothing to disclose.

Medical Editor

Christopher Luzzio, MD, Clinical Assistant Professor, Department of Neurology, University of Wisconsin at Madison
Christopher Luzzio, MD is a member of the following medical societies: American Academy of Neurology
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association
Disclosure: Nothing to disclose.

CME Editor

Matthew J Baker, MD, Consulting Staff, Collier Neurologic Specialists, Naples Community Hospital
Matthew J Baker, MD is a member of the following medical societies: American Academy of Neurology
Disclosure: Nothing to disclose.

Chief Editor

Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association
Disclosure: Nothing to disclose.

 
 
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