Neck pain and Headache Complicated by Persistent Syringomyelia

Neck Pain Complicated by Syringomyelia after Foramen Magnum Decompression

Patients with Arnold-Chiari Malformation I (CM-I) treated with foramen magnum decompression (FMD) can have ongoing neck pain, headaches, and other symptoms complicated by persistent syringomyelia, yet there is little research regarding treatment of these symptoms. Case Report: A 62-year-old woman with a history of residual syringomyelia following FMD and ventriculoperitoneal shunt for CM-I presented to a chiropractor with progressively worsening neck pain, occipital headache, upper ex- tremity numbness and weakness, and gait abnormality, with a World Health Organization Quality of Life score (WHO-QOL) of 52%. Symptoms were improved by FMD 16 years prior, then progressively worsened, and had resisted other forms of treatment, including exercises, acupuncture, and medications. Examination by the chi- ropractor revealed upper extremity neurologic deficits, including grip strength. The chiropractor ordered whole spine magnetic resonance imaging, which demonstrated a persistent cervico-thoracic syrinx and findings of cervical spondylosis, and treated the patient using a multimodal approach, with gentle cervical spine mobiliza- tion, soft tissue manipulation, and core and finger muscle rehabilitative exercises. The patient responded positively, and at the 6-month follow-up her WHO-QOL score was 80%, her grip strength and forward head posi- tion had improved, and she was now able to eat using chopsticks. This case highlights a patient with neck pain, headaches, and persistent syringomyelia after FMD for CM-I who improved following multimodal chiropractic and rehabilitative therapies. Given the limited, low-level evidence for these interventions in patients with persistent symptoms and syringomyelia after FMD, these therapies can- not be broadly recommended, yet could be considered on a case-by-case basis. https://amjcaserep.com/abstract/index/idArt/937826 Eric Chun-Pu Chu, Robert J Trager, Gabriel Siu Nam Ng, John Sing Fai Shum (2022) Neck pain and Headache Complicated by Persistent Syringomyelia After Foramen Magnum Decompression for Chiari I Malformation: Improvement with Multimodal Chiropractic Therapies American Journal of Case Reports 23: e937826. September. http://dx.doi.org/10.12659/AJCR.937826 Arnold-Chiari Malformation • Chiropractic • Exercise Therapy • Manipulation, Spinal • Neck Pain • Therapy, Soft Tissue