Syringomyelia Clinical Trial
Official title:
Establishing the Pathophysiology of Primary Spinal Syringomyelia
The goal of this study is to establish the mechanism(s) of progression of primarily spinal
syringomyelia (PSS). Our preliminary study of syringomyelia emphasized syringomyelia
associated with craniocervical junction abnormalities (CCJAS), such as the Chiari I
malformation. This new protocol will expand the scope of our investigation to include
primarily spinal syringomyelia (PSS), which is defined as syringomyelia not associated with
craniocervical junction abnormalities (CCJAS). Etiologies of primarily spinal syringomyelia
include 1) intradural scarring which is post-traumatic, post-inflammatory, or post-operative,
2) intradural-extramedullary masses such as arachnoid cysts or meningiomas, and 3)
extramedullary-extradural spinal lesions such as cervical spondylosis or spinal deformity.
Our hypothesis is the following: Primarily spinal syringomyelia (PSS), results from
obstruction of cerebrospinal fluid (CSF) flow within the spinal subarachnoid space; this
obstruction affects spinal CSF dynamics because the spinal subarachnoid space accepts the
fluid that is displaced from the intracranial subarachnoid space as the brain expands during
cardiac systole; in the case of primarily spinal syringomyelia (PSS), a subarachnoid block
effectively shortens the spinal subarachnoid space, reducing CSF compliance and the capacity
of the spinal theca to dampen the subarachnoid CSF pressure waves produced by the brain
expansion during cardiac systole; the exaggerated spinal subarachnoid pressure waves occur
with every heartbeat and act on the spinal cord above the block to drive CSF into the spinal
cord and create a syrinx. Presyringomyelia, a recently described state of spinal cord edema
associated with progressive myelopathy and obstruction in CSF flow, is a precursor stage to
syringomyelia that is consistent with this hypothesis. Because of the importance of this
condition to the pathophysiology of syringomyelia, we will also study patients with
presyringomyelia in this protocol. After a syrinx is formed, the enlarged subarachnoid
pressure waves compress the external surface of the spinal cord, propel the syrinx fluid, and
promote syrinx progression.
Many neurosurgeons at prominent academic centers routinely use syrinx shunts to treat
primarily spinal syringomyelia. This study should provide data that a surgical procedure that
opens the spinal subarachnoid space corrects the underlying pathophysiology and resolves the
syrinx and that invasion of the spinal cord is unnecessary.
Objective: The goal of this study is to establish the mechanism(s) of progression of
primarily spinal syringomyelia (PSS), the type of syringomyelia that is associated with
pathology in the spinal column and not at the craniocervical junction. Our hypothesis is that
when a lesion obstructs the spinal subarachnoid space, it shortens the segment of spinal
canal that dampens the CSF pressure waves that are produced with each heartbeat and creates
enlarged spinal subarachnoid pressure waves that act on the spinal cord above the block to
drive CSF into the spinal cord and create a syrinx. After a syrinx is formed, enlarged
subarachnoid pressure waves compress the external surface of the spinal cord, propel the
syrinx fluid, and promote syrinx progression.
Study Population: Subjects will have primary spinal syringomyelia associated with 1)
intradural scarring which is post-traumatic, post-inflammatory, or post-operative, 2)
intradural-extramedullary masses such as arachnoid cysts or meningiomas, and 3)
extramedullary-extradural spinal lesions such as cervical spondylosis or spinal deformity, or
4) an intramedullary tumor.
Design: Subjects will have testing before and after standard surgical therapy of
syringomyelia. Testing includes measurement of CSF pressure, neurologic examination,
CT-myelography, and MR scanning. Results of CSF pressure measurements before surgery will be
compared to measurements from normal controls that were previously studied. The effect of
surgery on CSF pressure, neurologic examination, CT-myelography, and MRI scans will be
evaluated.
Outcome Measures: The primary outcome measure is cervical CSF pulse pressure, which is the
amplitude of the CSF pressure wave, compared to normal values. Secondary outcomes measures
include change in CSF pulse pressure, neurologic examination, CT-myelography, and MRI scans
between before and after surgery.
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