Multilevel Cervical Laminoplasty and Syringotomy for a Long-Segment Cervical Syrinx Mimicking an Intramedullary Tumor: A Case Report

Background: Long-segment intramedullary cervical cord lesions can present a diagnostic challenge, particularly when imaging findings raise suspicion of an intramedullary neoplasm. Differentiating a syrinx from an intramedullary tumor is important for operative planning, as the surgical strategy may differ substantially.Case presentation: A 43-year-old female presented with a six-month history of progressive cervical pain with radicular symptoms, vertigo, left upper-limb sensory disturbance, and impaired left-hand grip. Neurological examination revealed preserved motor power of 5/5 in all four limbs, normal reflexes, and reduced functional grip in the left hand. MRI of the cervical spine demonstrated a long-segment expansile intramedullary lesion extending from the cervicomedullary junction to C7, without contrast enhancement. The radiological report also described Chiari malformation and syringomyelia. Given the diagnostic uncertainty and progressive symptoms, we performed urgent surgical exploration within two days of admission. We performed a C3–C7 laminoplasty to provide multilevel posterior access while preserving the laminar elements without instrumented fixation. Following durotomy and midline myelotomy, a syrinx was identified, with no obvious intramedullary tumor. Syringotomy and drainage were performed, and adjacent spinal cord tissue was obtained for biopsy. Graft duraplasty and reconstruction of the elevated laminae were completed. The patient had an uncomplicated postoperative course, with relief of pain and vertigo and resolution of sensory symptoms. She was discharged with intact motor power and improved but residual left-hand grip weakness. Follow-up MRI demonstrated cord decompression and drainage of the syrinx.Conclusion: This case illustrates the diagnostic uncertainty that may arise when a long-segment non-enhancing intramedullary cervical lesion is suspected to represent a tumor. Intraoperative findings guided the surgical procedure toward syringotomy and drainage, with tissue sampling to investigate a possible underlying neoplasm. Multilevel laminoplasty provided posterior access while allowing reconstruction of the cervical laminar elements. Histopathological confirmation and longer-term follow-up remain necessary.