Syringomyelia treatment: medications, massage, surgery

Surgical treatment is considered the main way to get rid of syringomyelia. Drug therapy can only alleviate the symptoms of the disease.

Vitamin therapy plays an important role: it is appropriate to use vitamins of group B, as well as ascorbic acid, vitamins D, K, E. Additionally, appoint:

• nootropic drugs that improve the trophism of the nervous tissue (Piracetam);
• diuretics (Furosemide, Diacarb);
• neuroprotectors (Actovegin, glutamic acid);
• antidepressants, anticonvulsants, opioids;
• ganglion blockers (Pachikarpin).

Acupuncture has a good healing effect. Tissue repair is stimulated by reflex stimulation of certain points on the body using the finest needles according to a special technique.

Additionally, massage procedures, physiotherapy exercises are prescribed.

As a pathogenetic treatment, X-ray therapy is prescribed, which can alleviate or soothe pain and numbness, reduce the area of loss of sensitivity, improve sensitivity and eliminate autonomic disturbances. This type of treatment is based on the ability of X-rays to contain the growth of glial structures. Thanks to this, it is possible to slow down the progression of the disease. But X-ray therapy is not indicated in all cases. It is used only in the initial stages of syringomyelia. If the disease goes too far, then irreversible disorders occur in the tissues, which X-ray therapy is not able to correct.

Currently, radioactive phosphorus, which has beta radiation, and radioactive iodine with beta and gamma rays are actively used for the treatment of syringomyelia . The therapeutic effect of radioactive substances is due to the high sensitivity to radiation of rapidly developing glial structures. Radioactive accumulations delay their development and even contribute to destruction.

Medicines

The choice of drugs and the preparation of a drug therapy regimen for syringomyelia is a rather difficult task for a doctor. It is advisable to carry out a combination pharmacological therapy - in particular, antidepressants in combination with anticonvulsants, local anesthetic drugs and opioids. For neuropathic pain, conventional analgesics and non-steroidal anti-inflammatory drugs are ineffective.

• Among the various antidepressants, amitriptyline is especially popular, which is prescribed at the rate of 25-150 mg per day. Therapy begins with the lowest possible dosage (10 mg per day), with a further increase. Amitriptyline and other tricyclic antidepressants require caution when used in patients with concomitant cardiovascular diseases, glaucoma, urinary disorders and disorders of the autonomic nervous system. In elderly patients, the drug can cause vestibular and cognitive abnormalities.
• Generation I anticonvulsants are capable of blocking sodium channels and inhibiting ectopic activity in presynaptic sensory neurons. For severe neuropathic pain, carbamazepine is effective in about 65% of cases, but its use may be accompanied by unwanted side effects such as dizziness, double vision, intestinal disorder, and cognitive impairment. The best tolerance is the drug Gabapentin, which is prescribed at 300 mg per day, with a gradual increase in dosage to 1800 mg per day and above. Another analogue is Pregabalin. It is used starting with a dosage of 150 mg per day, with a possible further increase to 300 mg per day. The maximum amount of the drug is 600 mg per day.
• Opioids are prescribed only in extreme cases, as their use can be accompanied by a number of complications, including the development of drug dependence. Tramadol at a dosage of 400 mg per day is considered effective: patients note a significant decrease in the intensity of pain and an increase in physical activity. To reduce the risk of developing addiction, the drug is taken with small doses: 50 mg 1-2 times a day. An increase in dosage is possible every 3-7 days (maximum - 100 mg 4 times a day, and for elderly patients - 300 mg a day).
• Topical pain relievers include a lidocaine patch or an external drug Capsaicin. In case of neuralgic status, in addition to the main treatment, Diazepam and vascular agents (Pentoxifylline, nicotinic acid, etc.) are prescribed.
• Additionally, neuroprotectors, antioxidants and decongestants (diuretics) are prescribed.

If medical therapy is ineffective, it is advisable to consider surgical treatment.

Actovegin for syringomyelia

The drug Actovegin is quite common: it is actively used as a universal antihypoxic and neuroprotective agent. Actovegin increases the uptake and assimilation of oxygen, as a result of which energy metabolism improves, and the cells acquire resistance to the state of hypoxia. In addition, the drug stimulates the transfer of glucose, which, in case of cerebrovascular pathologies, improves its transportation through the blood-brain membrane.

The neuroprotective effect of Actovegin lies in its ability to enhance the survival of nerve cells.

Other useful properties of the drug:

• has a combined pleiotropic effect with metabolic, neuroprotective, vasoactive effect;
• activates glucose transfer, increases oxygen utilization, improves the energy state of neurons;
• reduces the severity of apoptosis, reduces the manifestation of oxidative stress;
• improves capillary blood circulation and metabolic activity of the microvascular endothelium.

Actovegin is generally well tolerated. Allergic reactions are rare. The dosage is determined by the attending physician on an individual basis.

Physiotherapy treatment

At the stage of rehabilitation in syringomyelia, various physiotherapeutic methods are widely used, the purpose of which is to increase the functional abilities of the body, support the "activation" of adaptation mechanisms, and reduce the severity of symptoms of the disease. Most often, electrostimulation, magnetotherapy, phono and electrophoresis of medicines are prescribed.

Magnetotherapy is prescribed not only to eliminate unpleasant symptoms in syringomyelia, but also to accelerate recovery after spinal injuries, to improve wound healing, and to correct spinal circulation. Contraindications are considered purulent-inflammatory processes, cancer, pregnancy, systemic blood diseases.

It is possible to use INFITA-therapy - bioresonance treatment using a pulsed low-frequency electromagnetic field.

Other physiotherapeutic methods used include:

• Electroneurostimulation of muscles is a procedure aimed at functional restoration of damaged muscle and nervous tissue. For treatment, impulse currents of different frequencies and strengths are used.
• Ultrasound treatment, phonophoresis is the use of mechanical vibrations for therapeutic purposes at a frequency exceeding 16 kHz (more often - 800-3000 kHz).
• Medication electrophoresis is used to introduce medicinal solutions into body tissues using galvanic current. This is a low voltage direct current. Medicines penetrate the tissues in the form of positively and negatively charged particles through the intercellular pores, the mouth of the glands.
• Diadynamic therapy involves the effect on the body of Bernard's currents, which have a powerful analgesic effect: the currents affect the skin receptors and block the conduction of the pain impulse. In addition to pain relief, the procedure has an anti-inflammatory effect, improves blood circulation and reduces tissue swelling.
• Treatment with ozokerite and paraffin helps to revitalize small-vascular blood circulation, improve regional hemodynamics and tissue trophism, accelerate the regeneration of peripheral nerve fibers, reduce muscle rigidity and resorb inflammatory elements and cicatricial formations.

Massage

Conservative therapy for syringomyelia is always supplemented by massage and remedial gymnastics, including general developmental and breathing exercises, the use of gymnastic devices.

Sessions of vibration massage using needle vibratodes are shown. The cervicothoracic zone of the spinal column, as well as the upper limbs, are massaged for about 7-8 minutes daily. The treatment course consists of 14-15 procedures. It is recommended to take one course every three or four months.

They practice segmental reflex massage. At the first stage, the back area (paravertebral zones) is massaged, segmental massage techniques, and warm-up are used. Further, with pronounced disturbances in the innervation of the muscles of the upper extremities, the muscles of the arms and shoulder girdles are kneaded.

After spinal massage, kneading of the gluteal muscles and lower limbs is performed. The legs are massaged starting from the proximal areas. The basic massage technique is kneading in combination with muscle stroking and shaking.

The duration of the massage session is up to 20 minutes. The treatment course consists of 16-20 sessions. It is recommended to repeat the courses once every 3-4 months. Additionally, physiotherapy exercises, electrical stimulation are prescribed.

Herbal treatment

Unfortunately, alternative remedies cannot cure syringomyelia. However, they can significantly enhance the effect of drug therapy, accelerate the rehabilitation of patients after surgery, relieve pain and improve the conduction of nerve impulses.

Alternative healers use herbal decoctions, alcohol tinctures and water infusions for treatment:

• Rhizome of the caper bush in the amount of 2 tsp. Pour 200 ml of boiling water and continue to boil over low heat for 10 minutes. Then remove from heat, cover with a lid and insist for about half an hour. Filter and take 1 tbsp. L. Five times a day, between meals.
• Collect the bark of a chestnut tree, chop it. One tablespoon of raw materials is poured into 0.4 liters of drinking water at room temperature, covered with a lid and insisted for 8-10 hours (it is possible overnight). The resulting infusion is filtered and taken in 50 ml 4 times a day.
• The rhizome of the cimicifuga (Vorontsa) is used in the form of an alcoholic tincture, which can be purchased at a pharmacy or prepared independently. Cut the rhizome as small as possible, pour 70% alcohol in a 1: 5 ratio. It is kept sealed for a week and then filtered. For treatment, take 25 drops of the drug three times a day with 50 ml of water.
• Clover is a good and affordable remedy for syringomyelia. Medicinal raw materials in the amount of 3 tsp. Steamed in 200 ml of boiling water, infused under the lid for 2 hours. After filtration, the infusion can be taken: 50 ml four times a day. Filtered raw materials can also be used for treatment: it is useful for applying compresses to the affected areas of the body.

Surgery

A little earlier, surgeons with syringomyelia performed cystic shunting with a silicone device, with the ability to drain fluid from the cystic cavity into the abdominal or pleural cavity, as well as into the subarachnoid space. To date, surgical intervention has changed somewhat: doctors are trying to direct their actions to eliminate the fixation of the spinal cord and restore the circulation of cerebrospinal fluid, and only after that they get rid of the painful consequences. [1]

For shunting, a laminectomy or arcotomy is performed, the dura mater is opened, myelotomy is performed along the posterior longitudinal slit for 1-2 mm, the syringomyelitis cavity is opened, and the silicone shunting device is implanted in the cranial or cranial-caudal direction by about 4 cm. After that, the catheter is fixed in subarachnoid space or displayed in the cavity (pleural, abdominal). [2]

To eliminate spinal fixation and restore CSF circulation, resection or osteoplastic laminectomy is performed according to the level of cerebrospinal fixation, which should be determined at the stage of preparation for surgery. The dura mater is opened using a linear incision, with the possible use of intraoperative ultrasound control. Using microscopic equipment, the dura mater and arachnoid are separated, while dissecting the adhesions. If necessary, a syringo-subarachnoid shunt is implanted. [3]

The patient's condition before and after surgery is assessed according to criteria such as the presence of sensory and movement disorders, the quality of gait, the functionality of the pelvic organs, and pain syndrome. A similar assessment is performed before surgery, after it at the stage of inpatient examination, 4 months after surgery and then every six months (with good dynamics - once a year). [4]

In some cases, surgeons perform a simple opening of the cystic cavity without shunting. Indeed, such an operation gives a quick positive effect, but the long-term prognosis is often unsatisfactory.

After surgical treatment in most patients, syringomyelia stops developing. And only a small number of patients have relapses: in such a situation, revision or re-intervention is required. [5]