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SYRINX / 12 year old girl
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SYRINX / 12 year old girl

My daughter saw an orthopedist due to the possiblity of scoliosis.  After a review of her x-rays, he determined that it was an extremely mild case.  During his review of the x-ray, however, he found that two of her verterbrae in her upper thorasic spine had never "un-fused."  As a precaution he ordered an MRI to look at the organs (e.g. kidneys) that were developing at the same time as the spine to rule out any other deficiencies.  

Although that MRI showed those organs to have developed normally, he found fluid in her spine.  His assitant told us that it was being called a syrinx.

Naturally, we did some online research and are very concerned.  She has not seen a nerosurgeon yet as we were just notified of this yesterday.  

Our daughter has no symptoms.  If indeed it is a syrinx, do they always grow and cause problems?  Is there a possiblity that there will never be an affect on her?  

Any advice would be greatly appreciated.  Thank you.

Bruce and Patty.
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Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

Without the ability to examine your daughter, obtain a history, and review her imaging (which is not part of our role on this website), I can not comment on whether or not her syrinx will have future implications and what the best course of action is. however I will try to provide you with some useful information.

Syrinx is a term used to describe a fluid-filled cavity within the spinal cord. Normally, in all individuals, there is s small area in the spinal cord called the central canal which contains cerebrospinal fluid. This is a fluid that bathes the brain and spinal cord. A syrinx usually results from enlargement of the central canal resulting from a blockage somewhere within the central nervous system to the flow of cerebrospinal fluid. The causes are multiple, and also depend on the location of the syrinx in the spinal cord. In children, syrinxes in the spinal cord may result from abnormalities higher up, in the area where the brain meets the spinal cord (this area is called the cranio-cervical junction). Such abnormalities include an Arnold-Chiari malformation, which is basically a developmental structural abnormality in the posterior fossa of the skull (in lay terms sort of the back part of the head) and one area of the brain called cerebellum. Arnold-Chiari malformations do NOT always have to be treated and may have absolutely no implications neurologically. However, sometimes, when they are causing pressure on the brainstem or are causing large syrinxes, they need to be surgically treated.

Other causes of syrnixes include prior trauma, spinal cord tumors, and spinal cord malformations.

Not all syrinxes cause symptoms, and could be asymptomatic, which it sounds like is the case in your daughter. Symptoms depend on the location of the syrinx (whether it is in the cervical, thoracic, or lumbar region of the spinal cord. These describe the areas of the spinal cord from the head down (cervical region is closest to the head). Syrinxes are often in the cervical region and may cause sensory symptoms in the arm such as loss of sensation to pain and temperature. Larger syrnixes cause weakness of the arms, sensory loss, and other symptoms.

Treatment of syrnixes depends first and foremost on the cause. Not all syrinxes have to be treated immediately, in some cases, when there are no symptoms and no abnormalities on neurologic examination, serial MRI scans can be done to monitor the syrinx. If treatment is indicated, it is surgical: the problem leading to abnormal flow of cerebrospinal fluid needs to be corrected and the fluid filled cavity needs to be drained.

This is a lot of information for you and it is understandably anxiety-provoking. My best advice for you would be to have your daughter evaluated by a pediatric neurologist. He/she may choose to do further imaging such as an MRI of the brain and a CSF flow study to better determine if there is an obstruction to CSF flow (called MRI cine flow study) and if so, where it is within the central nervous system. If surgery is deemed necessary, it is also important for this to be done at a high-volume center (one where there is a lot of experience with these procedures), by a spine surgeon/neurosurgeon with experience in this field. Evaluation at a university hospital and/or similar academic centers may be most beneficial to her.

Thank you for using the forum, I hope you find this information useful, good luck.
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