Disclosures: Eduardo B. Bermudez, MD: Nothing to disclose

Case Description: The patient was referred for evaluation of back pain. Her pain started several months ago with no inciting event. She described an intermittent, aching pain in the axial low back. Pain was provoked by prolonged sitting and lying supine, and improved with lying on the side. She also reported “clumsiness” since the pain began. She had tried anti-inflammatories with suboptimal relief. Her examination was notable for clonus at the ankles and scoliosis. She was sent for a scoliosis study to evaluate the extent of curvature. Due to the unusual upper motor neuron finding of ankle clonus she was also sent for an MRI.

Setting: Secondary care pain practice. 

Patient: A 14-year-old female with a history of scoliosis.

Assessment/Results: Her scoliosis series was notable for dextroscoliosis of 40 degrees in the thoracic spine and levoscoliosis of 33 degrees in the lumbar spine. Cervical and thoracic MRI were notable for the presence of a large syrinx extending from C2 to T12 and no cerebellar tonsillar herniation. She was referred to a neurosurgeon to discuss treatment options.

Discussion: The first and second most common etiologies for syrinx in children are Chiari 1 malformation and idiopathic, respectively. Scoliosis can be a presenting sign of a syrinx as syringomyelia can cause differential growth of the spinal cord. Neurologic deficits due to syrinx are variable, but may include gait disturbance, radiating pain, and upper motor neuron signs. Axial back pain is possible in syringomyelia, but pain complaints are more common in adults. This case was unique in that ankle clonus was the sole objective neurologic finding.​

Conclusion: This case illustrates the importance of a thorough, organized physiatric examination for patients presenting with back pain, scoliosis and clumsiness. In this case, the salient finding of clonus in an otherwise normal neurologic examination prompted advanced imaging that revealed an underlying syrinx.​

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/syrinx-as-an-unusual-etiology-of-low-back-pain-and-clonus-in-a-child-with-scoliosis-a-case-report/