Development of pre-syrinx state and syringomyelia following a minor injury: a case report

Abstract

Background: A generally accepted rule is that posttraumatic syringomyelia (PTS) results from spinal cord injury (SCI).

Case presentation: Here, we report the development of syringomyelia without SCI in a 54-year-old Caucasian man following a mild motor vehicle accident. The computed tomography on admission excluded an injury of the spine. Because of neck and back pain, magnetic resonance imaging was performed on day 3 post-injury and demonstrated minimal changes from a ligamentous strain at the cervicothoracic transition. Any traumatic affection of the bone, vertebral discs, intraspinal compartment, or spinal cord were excluded. Some limb weakness and neurogenic bladder dysfunction started manifesting within the following weeks. Repeated MRIs following the accident demonstrated arachnoid adhesions at the C1-2 level and spinal cord edema equivalent to a pre-syrinx state at 12 months and syrinx formation at 24 months. Because of further deterioration, decompression was performed at 36 months.

Conclusions: We conclude that even after a minor trauma PTS can occur and that medullary edema (pre-syrinx state) may precede syrinx formation.

Keywords: Pre-syrinx; Spinal cord injury; Syringomyelia; Trauma; Treatment.

Fig. 1

a Computed tomography of the cervical spine on admission demonstrates degenerative changes at C5/6. b T2-weighted magnetic resonance imaging (1.5 T, 3 mm slice thickness) 3 days later was performed because of neck pain without radicular or medullary symptoms. Degenerative changes were confirmed at C4–7, with mild canal stenosis at C4/5 (10.9 mm) and C5/6 (10.2 mm). A hemangioma at Th3 was observed. Myelomalacia was ruled out. c Short-T1 inversion recovery (STIR) magnetic resonance imaging with a large field of view demonstrates subtle prevertebral hemorrhagic effusion within the soft tissue (red arrow) as well as edema between the processi spinosi (yellow arrow) at the cervicothoracic transition

Fig. 2

a, b T2-weighted magnetic resonance imaging (1.5 T, 3 mm slice thickness) 12 months post-injury demonstrated the development of arachnoid adhesions at C1/2 (yellow arrow) and medullary edema at the cervical and upper thoracic level. As an incidental finding, a Th2/3 fracture occurred at the site of the hemangioma. c, d Following contrast enhancement, an underlying pathology could be excluded

Fig. 3

a, b T2-weighted magnetic resonance imaging (1.5 T, 3 mm slice thickness) 2 years post-injury demonstrated that the arachnoid cyst progressed and that a syrinx cavity developed while the medullary edema was still present. Arachnoid adhesions are marked by the yellow arrow. c, d The postoperative MRI following decompression, untethering, and drain placement revealed a minimal reduction of the arachnoid cyst but no resolution of the syrinx

Fig. 4

Timeline of events, clinical symptoms, and investigations. CT computed tomography, MRI magnetic resonance imaging