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SPINAL CORD SURGERY IS RISKY

Q. I have syringomyelia, which was diagnosed over a year ago by an MRI and by a second scan in December 1999. Can you tell me about this condition, including the real function of the spinal cord?

- S.A., North Canton, Ohio

A. The spinal cord is the primary route of "communication" between the brain and the rest of the body. Almost all the nerves that serve the body depart from and return to the spinal cord. The function of the spinal cord can be likened to an electrical junction box between the power source (brain) and the individual area wiring (peripheral nerves).

The spinal cord is a soft, tube-like and highly intricate structure of nerve cells that is protected from most trauma by the bony vertebrae of the spinal column. Nevertheless, the spinal column can be damaged in many ways: physical trauma, infection, disease, etc. When the spinal cord is damaged, bodily function can be totally or partially lost for organs and tissues served by nerves below the site of injury.

Syringomyelia is an abnormal accumulation of fluid in the cavity that runs down the middle of the spinal cord. When this fluid-filled sac enlarges and presses against the spinal cord from within, the result is a progressive neurologic deterioration. Syringobulbia is the same condition in the lower part of the brain.

Syringomyelia is most common in the cervical (neck) area, but can occur anywhere along the length of the spine. As more and more fluid accumulates, longer sections of the spinal cord are affected.

About half the time, this condition is present at birth and may worsen during the teen and early adult years. Often, children with this condition have other birth defects as well. The cause of this form of syringomyelia is not known. Syringomyelia can also occur in association with a tumor or following injury to the spinal cord.

Usually, the sensory nerves that detect pain or temperature change are the most affected. As the fluid extends further along the spinal cord, motor nerves are affected and spasms and weakness may be seen. Eventually, the muscles served by the affected nerves will begin to weaken.

The only known treatment is surgery, whereby the pressure is relieved to prevent further deterioration. Sometimes the fluid can be drained from the cavity by use of a shunt, similar to the procedure used in hydrocephalus. In the case of tumor-related syringomyelia, radiation treatment is added when all the tumor tissue can't be removed.

Syringomyelia brought on by injury to the spinal cord is also treated surgically if nerve damage worsens or if the pain is intolerable.

Spinal cord surgery is very complicated and difficult, and doesn't always correct the problem. Deterioration of the nervous tissue may be irreversible even if the surgery is successful.

I wish I could give you better news. I suggest you review the special circumstances of your situation with your neurosurgeon.

Update on domestic violence: A recent study showed that as many as 35 percent of women who are victims of domestic violence will seek treatment in an emergency room or other primary care setting. But other studies have shown that most of these women are only treated for their physical injuries. Their emotional and social issues are not only untreated, they aren't even addressed.

This is only partly explained by the fact that only half of primary care health professionals have any training in this area. Because even those who do have training often don't have the time to pay attention to the signs that point to domestic violence being the cause of an injury.

In addition, many professionals are concerned about pursuing this course of questioning because of the fear of offending someone, whether she has just suffered from domestic violence or not.

So if you or a loved one is the victim of domestic violence, please strongly consider bringing the subject up when there is interaction with a health professional.

Write to Allen Douma in care of kALIVE, 1777 N.E. Loop 410, San Antonio, Texas 78217, or e-mail him at DRFamily@aol.com. This column is not intended to take the place of consultation with a health-care provider.

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