Deprecated: Creation of dynamic property ACF::$fields is deprecated in /nas/content/live/csfflowdev/wp-content/plugins/advanced-custom-fields-pro/includes/fields.php on line 136

Deprecated: Creation of dynamic property ACF::$locations is deprecated in /nas/content/live/csfflowdev/wp-content/plugins/advanced-custom-fields-pro/includes/locations.php on line 130

Deprecated: Creation of dynamic property ACF::$cache is deprecated in /nas/content/live/csfflowdev/wp-content/plugins/advanced-custom-fields-pro/includes/cache.php on line 281

Deprecated: Creation of dynamic property ACF::$deprecated is deprecated in /nas/content/live/csfflowdev/wp-content/plugins/advanced-custom-fields-pro/includes/deprecated.php on line 228

Deprecated: Creation of dynamic property ACF::$json is deprecated in /nas/content/live/csfflowdev/wp-content/plugins/advanced-custom-fields-pro/includes/json.php on line 185

Deprecated: Creation of dynamic property ACF::$local is deprecated in /nas/content/live/csfflowdev/wp-content/plugins/advanced-custom-fields-pro/includes/local.php on line 884

Deprecated: Creation of dynamic property acf_loop::$loops is deprecated in /nas/content/live/csfflowdev/wp-content/plugins/advanced-custom-fields-pro/includes/loop.php on line 26

Deprecated: Creation of dynamic property ACF::$loop is deprecated in /nas/content/live/csfflowdev/wp-content/plugins/advanced-custom-fields-pro/includes/loop.php on line 270

Deprecated: Creation of dynamic property ACF::$revisions is deprecated in /nas/content/live/csfflowdev/wp-content/plugins/advanced-custom-fields-pro/includes/revisions.php on line 413

Deprecated: Creation of dynamic property acf_validation::$errors is deprecated in /nas/content/live/csfflowdev/wp-content/plugins/advanced-custom-fields-pro/includes/validation.php on line 26

Deprecated: Creation of dynamic property ACF::$validation is deprecated in /nas/content/live/csfflowdev/wp-content/plugins/advanced-custom-fields-pro/includes/validation.php on line 212

Deprecated: Creation of dynamic property acf_form_customizer::$preview_values is deprecated in /nas/content/live/csfflowdev/wp-content/plugins/advanced-custom-fields-pro/includes/forms/form-customizer.php on line 26

Deprecated: Creation of dynamic property acf_form_customizer::$preview_fields is deprecated in /nas/content/live/csfflowdev/wp-content/plugins/advanced-custom-fields-pro/includes/forms/form-customizer.php on line 27

Deprecated: Creation of dynamic property acf_form_customizer::$preview_errors is deprecated in /nas/content/live/csfflowdev/wp-content/plugins/advanced-custom-fields-pro/includes/forms/form-customizer.php on line 28

Deprecated: Creation of dynamic property ACF::$form_front is deprecated in /nas/content/live/csfflowdev/wp-content/plugins/advanced-custom-fields-pro/includes/forms/form-front.php on line 664

Deprecated: Creation of dynamic property acf_form_widget::$preview_values is deprecated in /nas/content/live/csfflowdev/wp-content/plugins/advanced-custom-fields-pro/includes/forms/form-widget.php on line 34

Deprecated: Creation of dynamic property acf_form_widget::$preview_reference is deprecated in /nas/content/live/csfflowdev/wp-content/plugins/advanced-custom-fields-pro/includes/forms/form-widget.php on line 35

Deprecated: Creation of dynamic property acf_form_widget::$preview_errors is deprecated in /nas/content/live/csfflowdev/wp-content/plugins/advanced-custom-fields-pro/includes/forms/form-widget.php on line 36

Deprecated: Creation of dynamic property acf_field_oembed::$width is deprecated in /nas/content/live/csfflowdev/wp-content/plugins/advanced-custom-fields-pro/includes/fields/class-acf-field-oembed.php on line 31

Deprecated: Creation of dynamic property acf_field_oembed::$height is deprecated in /nas/content/live/csfflowdev/wp-content/plugins/advanced-custom-fields-pro/includes/fields/class-acf-field-oembed.php on line 32

Deprecated: Creation of dynamic property acf_field_google_map::$default_values is deprecated in /nas/content/live/csfflowdev/wp-content/plugins/advanced-custom-fields-pro/includes/fields/class-acf-field-google-map.php on line 33

Deprecated: Creation of dynamic property acf_field__group::$have_rows is deprecated in /nas/content/live/csfflowdev/wp-content/plugins/advanced-custom-fields-pro/includes/fields/class-acf-field-group.php on line 31

Deprecated: Creation of dynamic property acf_field_clone::$cloning is deprecated in /nas/content/live/csfflowdev/wp-content/plugins/advanced-custom-fields-pro/pro/fields/class-acf-field-clone.php on line 34

Deprecated: Creation of dynamic property acf_field_clone::$have_rows is deprecated in /nas/content/live/csfflowdev/wp-content/plugins/advanced-custom-fields-pro/pro/fields/class-acf-field-clone.php on line 35

Deprecated: Creation of dynamic property JSON_API::$query is deprecated in /nas/content/live/csfflowdev/wp-content/plugins/json-api/singletons/api.php on line 6

Deprecated: Creation of dynamic property JSON_API::$introspector is deprecated in /nas/content/live/csfflowdev/wp-content/plugins/json-api/singletons/api.php on line 7

Deprecated: Creation of dynamic property JSON_API::$response is deprecated in /nas/content/live/csfflowdev/wp-content/plugins/json-api/singletons/api.php on line 8
The causal role of spinal cord pulsation in the development of syringomyelia – CSF Flow

The causal role of spinal cord pulsation in the development of syringomyelia

Objective

Current theories on the causes of syringomyelia have only one aspect in common, namely that syringomyelia results from cerebrospinal fluid (CSF) flow obstruction in all diseases associated with syringomyelia. Tethered cord syndrome is known to cause syringomyelia also in the absence of an obstruction to cranial-to-spinal CSF flow. We conducted this study to investigate this phenomenon in our patient population. We included not only patients with primary tethered cord syndrome but also patients with (posttraumatic or postoperative) secondary tethered cord syndrome although (or because) these patients have both CSF flow obstruction and tethered cord syndrome.

Methods

From 2003 to 2018 we diagnosed in 45 patients primary tethered cord syndrome. All underwent cardiac-gated phase-contrast magnetic resonance imaging (MRI) of CSF flow pulsation of the whole spine and the brain.

Results

In patients with primary tethered cord syndrome, CSF flow obstruction similar to that seen in association with intradural adhesions was detected only in the presence of diastematomyelia (12 patients). In patients without tethered cord syndrome, no relevant CSF pulsation was noted below lumbar vertebra 1 (L1). In patients with tethered cord syndrome and a low-lying conus, however, relevant pulsations were also detected in the lumbar subarachnoid space similar to the pulsations seen in the region of the lower thoracic spine in patients without a low-lying conus. Particularly important information on the aetiology of syringomyelia was obtained from a patient with posttraumatic syringomyelia and an untreated fracture-dislocation with a complete blockage of the spinal canal and thus with a complete obstruction of CSF flow. He developed marked syringomyelia in the region of the thoracic spine in spite of the complete absence of pulsation cranial to the syrinx. A decrease in syrinx cavity size after an untethering procedure in primary tethered cord syndrome is evidence of a causal role.

Conclusions

Apart from brain pulsation, spinal cord pulsation decisively contributes to the development of syringomyelia in some groups of patients. Cranial pulsation appears to play a less important role in these cases.