Treatment of syringomyelia: medications, massage, surgery

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

Vitamin therapy plays a major role: it is appropriate to use B vitamins, as well as ascorbic acid, vitamins D, K, E. Additionally, the following are prescribed:

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

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

Additionally, massage treatments and therapeutic exercise are prescribed.

X-ray therapy is prescribed as a pathogenetic treatment, which can relieve or alleviate pain and numbness, reduce the area of loss of sensitivity, improve sensitivity conduction and eliminate vegetative disorders. This type of treatment is based on the ability of X-rays to restrain the processes of proliferation 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 damage occurs in the tissues, which X-ray therapy is not able to correct.

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

Medicines

The choice of drugs and the development of a drug therapy regimen for syringomyelia is quite a complex task for a doctor. It is advisable to conduct combined pharmacological therapy - in particular, antidepressants in combination with anticonvulsants, local anesthetics and opioids. In case of neuropathic pain, conventional analgesics and non-steroidal anti-inflammatory drugs are ineffective.

• Among the various antidepressants, Amitriptyline is especially popular, prescribed at a rate of 25-150 mg per day. Therapy begins with the minimum possible dosage (10 mg per day), with its subsequent 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 deviations.
• First-generation anticonvulsants are capable of blocking sodium channels and inhibiting ectopic activity in presynaptic sensory neurons. In severe neuropathic pain, Carbamazepine is effective in approximately 65% of cases, but its use may be accompanied by undesirable side effects such as dizziness, double vision, intestinal upset, and cognitive impairment. The best-tolerated drug is Gabapentin, which is prescribed at 300 mg per day, with a gradual increase in dosage to 1800 mg per day and higher. 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 addiction. Tramadol is considered effective at a dosage of 400 mg per day: patients note a significant decrease in pain intensity and an increase in physical activity. To reduce the risk of addiction, the drug is taken starting with small doses: 50 mg 1-2 times a day. The dosage can be increased every 3-7 days (maximum - 100 mg 4 times a day, and for elderly patients - 300 mg per day).
• As local anesthetics, in particular, lidocaine patch or external preparation Capsaicin are used. 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 drug therapy is ineffective, it may be appropriate 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 capture and absorption of oxygen, as a result of which energy metabolism improves, and cells acquire resistance to hypoxia. In addition, the drug stimulates glucose transfer, which in cerebrovascular pathologies improves its transportation through the hematoencephalic membrane.

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

Other useful properties of the drug:

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

Actovegin is usually 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 for syringomyelia, various physiotherapeutic methods are widely used, the purpose of which is to increase the functional capabilities of the body, support the "switching on" of adaptation mechanisms, and reduce the severity of the symptoms of the disease. Most often, procedures of electrical stimulation, magnetic therapy, phono and electrophoresis of medications are prescribed.

Magnetotherapy is prescribed not only to eliminate unpleasant symptoms of syringomyelia, but also to speed up recovery after spinal injuries, to improve wound healing, to correct spinal blood circulation. Contraindications include purulent-inflammatory processes, oncological diseases, 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:

• Electrical neurostimulation of muscles is a procedure aimed at functional restoration of damaged muscle and nerve tissue. Pulsed currents of different frequencies and strengths are used for treatment.
• Ultrasound treatment and phonophoresis are the use of mechanical vibrations for therapeutic purposes at a frequency exceeding 16 kHz (more often 800-3000 kHz).
• Medicinal electrophoresis is used to introduce medicinal solutions into the body's tissues using galvanic current. This is a low-voltage direct current. Medications penetrate into the tissues in the form of positively and negatively charged particles through intercellular pores and gland orifices.
• Diadynamic therapy involves the impact of Bernard currents on the body, which have a powerful pain-relieving effect: the currents affect skin receptors and block the conduction of pain impulses. 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 revive small-vascular blood circulation, improve regional hemodynamics and tissue trophism, accelerate the regeneration of peripheral nerve fibers, reduce muscle rigidity and resolve inflammatory elements and cicatricial formations.

Massage

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

Shown are sessions of vibration massage using needle vibratodes. The cervical-thoracic area of the spine is massaged, as well as the upper limbs for about 7-8 minutes daily. The treatment course consists of 14-15 procedures. It is recommended to conduct one course every three or four months.

Segmental-reflex massage is practiced. At the first stage, the back area (paravertebral zones) is massaged, segmental massage techniques and warm-up are used. Then, in case of pronounced disorders of innervation of the muscles of the upper limbs, the muscles of the arms and shoulders are warmed up.

After the spinal massage, the gluteal muscles and lower extremities are kneaded. 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 a 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, therapeutic physical training and electrical stimulation are prescribed.

Herbal treatment

Folk remedies, unfortunately, cannot cure syringomyelia. However, they can significantly enhance the effect of drug therapy, speed up the rehabilitation of patients after surgery, relieve pain and improve the conduction of nerve impulses.

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

• 2 teaspoons of caper bush rhizome are poured with 200 ml of boiling water and continue to boil on low heat for 10 minutes. Then remove from heat, cover with a lid and leave for about half an hour. Filter and take the remedy 1 tablespoon five times a day, between meals.
• Collect the bark of the chestnut tree and grind it. One tablespoon of raw material is poured with 0.4 liters of drinking water at room temperature, covered with a lid and infused for 8-10 hours (can be overnight). The resulting infusion is filtered and taken 50 ml 4 times a day.
• The rhizome of black cohosh (crow's tongue) is used in the form of an alcohol tincture, which can be purchased at a pharmacy or prepared independently. The rhizome is cut as finely as possible, filled with 70% alcohol in a ratio of 1:5. Keep it sealed for a week, then filter. For treatment, take 25 drops of the product three times a day with 50 ml of water.
• A good and affordable remedy for syringomyelia is clover. Medicinal raw materials in the amount of 3 teaspoons are steamed in 200 ml of boiling water, infused under a lid for 2 hours. After filtering, the infusion can be taken: 50 ml four times a day. Filtered raw materials can also be used for treatment: it is useful for putting compresses on the affected areas of the body.

Surgical treatment

Not long ago, surgeons performed cystic shunting on patients with syringomyelia using 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. Today, surgical intervention has changed somewhat: doctors try to direct their actions to eliminating the fixation of the spinal cord and restoring the circulation of cerebrospinal fluid, and only then 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 fissure for 1-2 mm, the syringomyelic cavity is opened and a shunting silicone device is implanted in the cranial or cranial-caudal direction by approximately 4 cm. After this, the catheter is fixed in the subarachnoid space or brought out into the cavity (pleural, abdominal). [ 2 ]

To eliminate spinal fixation and restore cerebrospinal fluid circulation, resection or osteoplastic laminectomy is performed at 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 possible use of intraoperative ultrasound control. Using microscopic equipment, the dura mater and arachnoid mater are separated, simultaneously dissecting adhesions. If necessary, a syringo-subarachnoid shunt is implanted. [ 3 ]

The patient's condition before and after surgery is assessed by such criteria as the presence of sensory and motor disorders, gait quality, functionality of the pelvic organs, and pain syndrome. Such an 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, syringomyelia stops developing in most patients. Only a small number of patients experience relapses: in such a situation, revision or repeated intervention is required. [ 5 ]