| Dr. Miguel B. Royo Salvador Neurosurgery and Vertebral Column |
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<< Syringomyelia | |
<< Arnold Chiari I malformation | |||||||||||||
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"Scoliosis, syringomyelia and Arnodl Chiari malformation can be stopped." |
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SCOLIOSIS
What is brought into scoliosis
as a novelty by Institut Neurológic de Barcelona?.
Scoliosis or twisted spine affects 2% of the population and was first
described by Hippocrates 2.400 years ago, and what he said then as for
the explanation and treatment of the disease has barely been modified.
Currently, and according to our published research studies, scoliosis
is a disease caused by the tethering of the spinal cord by a ligament
called filum terminale which does not carry out any function in adults.
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Figure 3.- Case 3, patient of 19 with idiopathic scoliosis. A. Preoperation X-ray 38º. B. Postoperation, nine months after cutting the filum terminale, 31º. C. Preoperation dorsolumbar MRI, spinal cord goes from an intrathecal cavity to another.
Is this explanation of scoliosis of
any use to the patients?
Of course, with the simple section of this ligament the strain to which
the spinal cord is subject stops, and then the flexion-producing stimuli
stop being sent to the vertebral column so the progression of scoliosis
stops.
Does the section of the filum terminale
bring the twisted vertebral column back to its upright position?
If the human spine had the plasticity and elasticity of a spring or if
it was made of rubber, it would move back to its original upright position.
But the column has developed under an intense strain that made the bones,
joints and ligaments bend for years. When it is freed from this strain,
its recovering depends on its degree of plasticity, which in time depends
on the age of the patient, the genes, the time and intensity of the strain.
Then, what is the use of cutting this
ligament?
The first thing achieved by cutting the filum terminale is supressing
the main strain that makes the disease progress. This way, when scoliosis
develops rapidly, the progression of the disease is greatly stoped.
In some cases, when the operation is carried out at an early stage, after
cutting the filum terminale the vertebral column may spontaneously straighten
up a few degrees, and some more if correct neurorehabilitation follows.
If the operation is carried out at an advanced stage of scoliosis, in
spite of the supression of the flexion-producing strain of the filum terminale,
the vertebral unbalance itself becomes another flexion-producing strain
that would require intense neurorehabilitation action, by means of a corset
o surgery with a vertebral fixation system. In all cases, the section
of the filum terminale is reccommended in order to improve the effect
of any therapeutical actions taken and to minimize the aggression to the
spinal cord when it is pulled by the action of corsets or the surgical
correcting measures.
What exactly is the surgical section
of the filum terminale?
The surgical section of the filum terminale is carried out by making a
small incision on the sacrum, at the end of the backbone, so there is
no alteration of the spine mechanics, visualizing the filum terminale
and cutting it by means of microsurgery techniques, all of which is done
in hardly half an hour and the patient is in hospital less than a day.
What are the consecuences of cutting
this ligament?
The filum terminale is the result of the empty cover of the spine cord
at the lower back or lumbosacral region. In the human embryo, the vertebral
column and the spinal cord inside it have the same length and they are
separated by some membranes, namely, dura mater, arachnoid mater and pia
mater. With the normal growth of the person, the vertebral column grows
about twenty centimeters more than the spinal cord. The layers that separate
the spinal cord from the vertebral column in the lower back region do
not contain spine cord anymore and fold as a fibrous cord which forms
the filum terminale; this portion of the spinal cord can be compared to
a sock we are wearing and we pull taking it half way off our foot: the
half that does not contain our foot could be cut with no risk to our foot.
In much the same way, the filum terminale can be cut at any point with
no harm (1, 2).
Is the surgical operation useful given
any case of scoliosis?
The operation of the filum terminale is only applicable in cases of the
socalled idiopathic scoliosis or scoliosis of unknown cause, and it does
not apply in the rest of cases, like those of degenerative scoliosis,
scoliosis derived from neoplasia or cancer, paralytic scoliosis and others
(3).
Does tethering of the spinal cord
have any effects on the brain?
The strain of the filum terminale, besides forcing the spine to bend,
in order to prevent the strain of the spinal cord, it also pulls downward
the lower part of the brain, the socalled cerebellar tonsils, into the
foramen occipitalis which connects the skull to the spine, causing the
Arnold Chiari malformation, a disease described 100 years ago and was
of unknown cause up to present.
The surgical section of the filum for Arnold Chiari malformation makes
the downward strain disappear for the cerebellar tonsils, it stops them
from suffering because they do not opress themselves into the foramen
occipitalis anymore. The operation improves many of the symptoms of the
disease and the cerebellar tonsils do not move upwards because they are
deformed and because of their little elasticity.
Does the spinal cord suffer because
of the tethering?
Research and tests with animals have proven that a mild tethering of the
spinal cord makes neurons stop functioning due to insufficient blood flow.
In humans, intense tethering decreases blood flow inside the spinal cord,
because there are important arteries there for the spinal cord and because
spinal cord arteries are centripetal, they go from the outside to the
inside, especially at the cervical region, since there is the limit to
the downward movement. The lack of blood flow causes the necrosis or death
of part of the spinal cord tissue, and then it attracts interstitial fluid
from within the spine and forms a cyst in the centre of the spinal cord
called syringomyelic cavity, syrinx or Syringomyelia, a disease described
500 years ago, of unknown cause up to present .
Does this mean that syringomyelia
can also be treated with the same surgical technique as scoliosis?
In a similar way to scolisis, in the case of syringomyelia the section
of the filum terminale stops the disease. The cyst resulting from the
necrosis remains the same, but it may disappear when the space surrounding
the spinal cord opens spontaneously or does so towards its centre where
there is the ependymal canal, which connects the centre of the spinal
cord to the brain cavities. The symptoms of the disease are caused by
the cell death and the tumor-like effect of the cyst. The section of the
filum has three beneficial effects: it stops the death of cells caused
by spine cord strain, it helps recover the non functioning but alive neurons,
and it diminishes the tumor-like effect of the cyst because it relaxes
the spinal cord.
Has this treatment been applied to
patients?
Patients of the three diseases, that is, scoliosis, Arnold Chiari malformation
and syringomyelia, have been operated; some had all three conditions,
and in some cases, the improvement has been dramatic.
Can you give an example?
A forty-eight year old woman had a very pronounced scoliosis; she had
had back pains since the age of fourteen, whatever position she was in,
even lying in bed, when getting up, when rolling constantly, she did not
have a pause for thirty-four years. She was operated seven months ago
and has not had the slightest vertebral pain since.
One case of syringomyelia: a young man of twenty-five, he had no sense
for temperature on the left side of his body and had a big cyst in the
centre of the spinal cord (case 2 of publication 3). Six hours after the
operation, the specialist verified the total recovery of the patient’s
sense of touch, the improvement lasting to present, five years later.
This patient now works in a warehouse in Galicia, while other specialists,
at the sight of his serious injuries predicted total disability in two
years after diagnosing syringomyelia.
Bibliography
1. Siringomielia, escoliosis y malformación de Arnold-Chiari
idiopáticas, etiología común (PDF).
2. Platibasia, impresión basilar, retroceso odontoideo y kinking
del tronco cerebral, etiología común con la siringomielia,
escoliosis y malformación de Arnold-Chiari idiopáticas (PDF).
3. Nuevo tratamiento quirúrgico para la siringomielia, la escoliosis,
la malformación de Arnold-Chiari, el kinking del tronco cerebral,
el retroceso odontoideo, la impresión basilar y la platibasia idiopáticas
(PDF).
4. "Results of the section of the filum terminale in 20 patients
with syringomyelia, scoliosis and Chiari malformation". Acta Neurochir
(Wien). 2005 Feb 24 (PDF).
5. "Aportación a la etiología de la siringomielia".
PhD thesis (PDF).