Active Conservative Management of Primary Spinal Syringomyelia: A Scoping Review and Perspectives for an Activity-based Clinical Approach

Abstract

Objective: This scoping review aimed to identify and synthesize existing research on active conservative management of primary spinal syringomyelia and associated symptoms and to discuss perspectives for clinical application using an activity-based approach.
Methods: PubMed, Embase, Scopus, and Web of Science were systematically searched for empirical studies of conservative management or therapies of adults with primary spinal syringomyelia from inception to April 2021. In addition, abstracts from relevant conferences were searched. Study characteristics and key findings were extracted, and findings descriptively synthesized.
Results: Of 1,186 studies screened, 7 studies met the eligibility criteria (4 single case studies and 3 cohort studies, a total of 90 individuals). The interventions were primarily physiotherapeutic, mostly by posture correction and exercises, and effects were alleviation of pain, improved physical function, improved activities of daily living and quality of life. Analysis of factors triggering symptoms and rationale for choice of intervention based upon these was limited.
Conclusion: Evidence of active conservative management of primary spinal syringomyelia and associated symptoms is limited. Many variations and limitations in the existing research limit the conclusions. High-quality research is needed to enable healthcare professionals to apply evidencebased active conservative interventions.

LAY ABSTRACT
People with primary spinal syringomyelia and associated symptoms are often managed conservatively. In most cases, this means without active treatment. Pathophysiological knowledge and our own physiotherapeutic experience propose that the symptoms may be connected to specific active movements and activities of daily life. The aim of this study was to map existing evidence for active rehabilitation as a means of reducing symptoms and preventing syrinx progression. Only 7 low-quality research studies with different kinds of treatment were found. Mostly, physiotherapy was offered with exercises and focus on posture. Outcomes included alleviation of pain as well as improved physical function and quality of life. Unfortunately, analysis of symptominducing factors to guide the choice of intervention was limited. Future high-quality studies are needed to develop active conservative interventions for people with primary spinal syringomyelia.