Hydromyelia is an expansion of the central canal of the spinal cord. It is a narrow cavity filled with cerebrospinal fluid. The canal is located throughout the entire spinal cord, at the top communicating with the fourth ventricle of the brain, and at the bottom, it expands and then ends blindly. At this level, it is called the terminal ventricle.
Spinal cord injury remained a complex pathology to diagnose for a long time. As a rule, the diagnosis was established already with a detailed clinical picture, which significantly worsened the prognosis and the rehabilitation possibilities. Currently, because of the availability of methods of radiation diagnostics, many pathologies of the nervous system are detected even at the asymptomatic stage and, in fact, are accidental findings during the study. Hydromyelia also belongs to such diseases.
Often, hydromyelia is combined with hydrocephalus – an excess of fluid and increased pressure in the brain’s ventricular system.
The prevalence of hydromyelia in different age categories varies by orders of magnitude: from one case per million in early childhood to 2.5-2.7 cases per 100,000 people over 60 years of age.
General information about hydromyelia
Hydromyelia is a pathological condition in which the volume of cerebrospinal fluid is significantly increased in the central spinal canal and, accordingly, its pressure is increased. Sometimes you can find the informal name “dropsy of the spinal cord”. In popular medical texts, hydromyelia is often described in the same context as another disease – syringomyelia, and sometimes these diagnoses are interpreted as synonyms. In fact, these are two different types of pathology. In the International Classification of Diseases, they are encoded by different codes and are not synonyms: with syringomyelia, due to progressive gliosis, cavities are formed in the gray matter of the spinal cord, while hydromyelia in the exact meaning implies the expansion of the canal while intact (almost always) ependyma, i.e. the membrane lining the canal, and the safety of the neurons of the gray spinal substance.
Reasons for appearing
Hydromyelia can act either as a congenital anomaly (an enlarged canal forming at the stage of intrauterine development) or as a pathology resulting from trauma, neuro infections, tumor process, hemorrhage, dystrophy, and other painful conditions.
Various factors can provoke the development of the pathological process. Depending on the cause of the occurrence, hydromyelia is divided into congenital and acquired forms. The congenital form can occur against the background of anomalies in the development of the spine, affecting the formation of the spinal canal. In such patients, the disease is often asymptomatic; therefore, it is detected at later stages.
The acquired form of the disease may be the result of such ailments and circumstances as:
- injury to the spinal column;
- tumor formations of any nature of origin;
- inflammatory lesion of the spinal cord;
- infectious pathologies;
- hydrocephalus (dropsy of the brain);
- spinal cord compression;
- dystrophic changes in tissues;
- spinal canal atrophy;
- Paget’s disease can also cause this disorder, in which bone tissue is affected, and the spine and spinal canal are deformed.
Symptoms of Hydromyelia
As a rule, radiological signs of hydromyelia are found in the cervical, less often in the thoracic spine. The clinical picture can vary significantly in different individual cases – from asymptomatic to polysymptomatic forms. Unlike syringomyelia, there is no loss of pain sensitivity; the majority of patients also retained the general tactile sensitivity of the fingers (its decrease is detected only in 35% of cases). Approximately half of the patients show muscle weakness and signs of muscle atrophy in the upper extremities. 60% have a tendency to cool them, imbalance in water balance (dry skin or sweating), and blue fingertips. Pain syndrome and limited mobility in the joints occur in every fifth case. Many patients complain of cramps, frequent purulent inflammation in the fingers, headaches, insomnia, and a tendency to swelling.
As a rule, symptoms progress slowly (over many years and decades).
The diagnosis is made on the basis of clinical, radiological, and tomographic (MRI) data.
The clinical picture of the disease depends on the location of the lesion, the cause of its occurrence, and the stage of development.
Often, at the initial stages, the disease is asymptomatic, but as it progresses, characteristic symptoms develop. Due to the increasing pressure of the fluid and the expansion of the canal, compression of the spinal cord occurs, which entails the occurrence of neurological symptoms.
The main signs of the pathological phenomenon include:
- atrophy of the muscles of the hands;
- blue discoloration of the fingertips due to impaired blood supply;
- muscle weakness;
- deterioration of tendon reflexes;
- feeling of coldness in the limbs;
- limitation of mobility of the upper limbs;
- swelling in the affected area;
- sleep disturbance;
- intense soreness radiating to the hands;
- visual changes in the spine (curvature);
- increase in local body temperature;
- an increase in temperature (observed with advanced stages of the disease);
- decreased sensitivity.
If you do not start treatment promptly, Hydromyelia, necrotic lesions of the fingers, and paralysis of the upper extremities may develop.
Treatment of hydromielia
After establishing an evidence-based diagnosis, including reliable differentiation of hydromyelia from symptomatically similar conditions, a therapeutic strategy is selected taking into account many factors (duration of the course, severity of clinical symptoms and morphological changes, dynamics of existing disorders, patient’s age, etc.). As a rule, an attempt is made to medically relieve symptoms with antihypertensive drugs, antispasmodics, vasodilators, and vitamin complexes. In more severe and therapeutically resistant cases, it is possible to restore the normal outflow of cerebrospinal fluid through neurosurgical bypass surgery; a number of authors consider such an intervention to be a preferable and more effective means in comparison with conservative therapy.
Treatment of the expansion of the central canal spinal cord depends on the factor of its development:
- Injury – first, the integrity of the spine structure is restored, and puffiness is removed.
- Oncological process – additional diagnostics are performed to determine the size of the formation, the presence of metastases and other characteristics. Based on the data received, the doctor selects the treatment.
- Infectious processes – a course of antibacterial agents is prescribed to destroy pathogenic microflora.
Thus, each specific case requires an individual approach in choosing a therapy regimen.
Important! Complete elimination of Hydromyelia is possible only with the help of surgical intervention. During the operation, a shunt is inserted, which helps remove accumulated excess fluid in the canal. Surgery is a method of complete cure of the disease.
Rehabilitation after hydromielia
After the operation, the patient undergoes rehabilitation, which includes the following methods:
- bed rest;
- wearing selected orthopedic products;
- taking medications: painkillers (Ketanov), combined preparations of B vitamins (Milgamma), antidepressants (Aleval).
Also, for 6 months, it is necessary to be monitored by a doctor and then once a year undergo an X-ray to control the situation.
Diagnostics of Hydromyelia
Symptoms and treatment of thoracic hydromyelia are interrelated. Before starting treatment, a specialist examines the patient. Diagnostics allows you to determine the causes of the development of the violation, the stage, and features of the course of the pathological process. After the initial examination, during which the patient’s complaints are clarified, an additional examination is prescribed to clarify the diagnosis using such hardware diagnostic techniques as:
radiography – to determine the presence of deformations, displacements, and other pathologies that provoke the development of hydromyelia;
CT, MRI – informative methods to detect the pathological expansion of the canal and to determine the features of the course of this process.
- The defeat of any structural element of the spinal column is fraught with serious consequences for human health. Therefore, if you have back pain and other characteristic symptoms, you should immediately visit a doctor.
- Preventive actions
- With regard to preventive measures aimed at preventing disease such as hydromyelia of the thoracic and cervical spine, doctors give the following tips and recommendations:
- It is necessary to correctly, and most importantly, timely treat all infectious and inflammatory processes occurring in the body and affecting tissues spinal cord; this will prevent the development of complications, negative consequences, including hydromyelia.
- In addition, doctors strongly recommend moving – morning exercises and a daily walk in the fresh air will allow you to maintain the entire body and the musculoskeletal system in its normal state. If the work is sedentary, the lifestyle is inactive, so it is recommended to do a 5-minute light warm-up every hour. You can just squat or tilt to the right or left, but if you experience pain, you should consult a doctor.
- Proper nutrition plays an important role in the prevention of Hydromyelia – timely food intake, refusal of harmful foods and dishes, adherence to the fractional principle of nutrition, when there are 5-6 times a day in small portions, will prevent the development of problems with the body and the spine, including.
- The patient is also advised to limit any excessive, intense loads on the back – lifting weights and abrupt changes in posture.
- You should avoid not only physical but also psychological overwork; this reduces the body’s defenses, making it more susceptible to negative external factors.