Is syringomelia associated with scoliosis?

Syringomyelia and Scoliosis Association

Yes, syringomyelia is definitively associated with scoliosis, with intraspinal abnormalities such as syringomyelia being found in 2-4% of cases initially thought to be idiopathic scoliosis. 1

Evidence for Association

The association between syringomyelia and scoliosis is well-documented in both clinical guidelines and research:

• According to the American College of Radiology, intraspinal abnormalities including syringomyelia are found in 2-4% of presumed "idiopathic" scoliosis cases 1
• Research demonstrates a "high incidence of developmental scoliosis" in patients with syringomyelia 2
• Studies have shown significant relationships between the location of syrinx and the characteristics of scoliosis 3

Clinical Presentation and Detection

Detecting syringomyelia in patients with scoliosis can be challenging because:

• Many cases present with mild or subtle neurological symptoms 4
• Only 10 out of 25 patients in one study had abnormal neurological findings despite having large syrinxes 5

Key clinical considerations:

• Warning signs that should prompt MRI investigation:
  • Subtle neurological deficits
  • Atypical curve patterns
  • Early onset scoliosis
  • Rapid curve progression
  • Spinal pain that doesn't respond typically to treatment 4

Relationship Between Syrinx and Scoliosis

The relationship between syringomyelia and scoliosis shows several patterns:

• There is a significant relationship between the most caudal level of the syrinx and the locations of scoliosis 3
• Patients with thoracolumbar/lumbar curves tend to have syrinxes with lower caudal extent compared to those with thoracic curves 6
• The side of syrinx deviation often does not correspond with the convexity of the scoliotic curve (only 27.2% concordance) 6

Management Implications

The presence of syringomyelia significantly impacts scoliosis management:

• Decompression of the syrinx can lead to improvement or stabilization of scoliotic curves in many cases 2

• After syrinx decompression:

  • 3 out of 4 patients without prior arthrodesis showed curve improvement at 35-month follow-up 2
  • 3 out of 5 patients with myelodysplasia showed stabilization or improvement at 21-month follow-up 2

• Bracing can be effective for curve control, but correction may not be maintained outside the brace for progressive or severe curves 5

• Surgical correction can be safely achieved in patients with both conditions 5

Clinical Pitfalls to Avoid

1. Failure to investigate for syringomyelia in atypical scoliosis cases

   • Liberal use of MRI is supported when neurological findings are present 5
   • Even subtle neurological signs should not be underestimated 5

2. Delayed diagnosis

   • Timely diagnosis is crucial for treatment planning 4
   • Patients with scoliosis and spinal pain that doesn't respond typically to treatment should be further investigated 4

3. Overlooking associated conditions

   • Chiari malformation and cord tethering frequently coexist with syringomyelia and scoliosis 3
   • These associated conditions significantly affect both the syrinx and scoliosis characteristics 3

In summary, the evidence strongly supports a significant association between syringomyelia and scoliosis, with important implications for diagnosis, monitoring, and treatment approaches.