Relieving Pressure Inside the Spinal Cord
Learning that there is a fluid-filled cavity inside your spinal cord can be unsettling, especially when it is causing pain, numbness or weakness. Many syrinxes shrink once their cause is treated, and when one keeps growing, syrinx surgery can often correct the problem by draining the fluid and taking pressure off the spinal cord.
What Is a Syrinx?
A syrinx is a fluid-filled cavity that forms inside the spinal cord, a condition called syringomyelia. It develops when the normal flow of spinal fluid around the spinal cord is blocked. Over time, the syrinx can expand and stretch the spinal cord from the inside.
The most common cause is a Chiari malformation. Others include scarring after a spinal cord injury, infection or bleeding (arachnoiditis), a tethered spinal cord and spinal cord tumors.
Who Needs Syrinx Surgery?
- A syrinx that is growing on repeat MRI scans
- Worsening symptoms such as pain, numbness, loss of temperature sensation in the hands, weakness or balance problems
- A syrinx that didn’t shrink after its cause was treated
Treatments to Try First
- Observation: small, stable syrinxes that aren’t causing symptoms are often watched with MRI scans
- Treating the cause: this is usually the first surgery. For a Chiari malformation, a Chiari decompression restores fluid flow and often makes the syrinx shrink. Removing a tumor or releasing a tethered cord can do the same.
- Pain management and physical therapy: to manage symptoms
How Syrinx Surgery Is Done
The operation depends on the cause. When a Chiari malformation or other blockage can be corrected, that surgery is done first. When the cause can’t be fixed, or the syrinx keeps growing, a shunt is placed:
- Anesthesia and monitoring: You’ll be fully asleep, with nerve monitoring throughout.
- Opening: A laminectomy removes a small piece of bone over the syrinx, and the dura is opened under the microscope.
- Releasing scar tissue: Any scar tissue blocking fluid flow around the spinal cord is released.
- Placing the shunt: A tiny opening is made in the spinal cord and a thin tube is placed into the syrinx. The other end drains into the space around the spinal cord, or sometimes into the chest or abdomen.
- Closing: The dura is closed watertight, and the muscles and skin are closed.
Watch Dr. Grunch explain a Chiari malformation with a cervical syrinx:
Video: Case Study 62, Chiari Malformation and Cervical Syrinx, presented by Dr. Grunch on her Ladyspinedoc channel (YouTube)
Benefits and Risks
Benefits
- Shrinks the syrinx and takes pressure off the spinal cord
- Often stops symptoms from getting worse, and can improve pain, numbness and weakness
Risks
- New or worsened numbness or weakness, which is often temporary
- Shunt blockage, or the syrinx coming back, which may need another surgery
- A spinal fluid leak
- Infection or bleeding
- Risks related to anesthesia
Why Choose Dr. Betsy Grunch for Your Syrinx Surgery
- Duke-trained: Dr. Grunch completed her neurosurgical residency and a spine research fellowship at Duke University School of Medicine, one of the top neurosurgery programs in the country.
- Treating the cause first: She looks for the reason the syrinx formed, such as a Chiari malformation, and corrects it whenever possible, so a shunt is used only when it is truly needed.
- Nerve monitoring and microsurgery: Spinal cord surgery is done under the operating microscope with continuous nerve monitoring to protect strength, sensation and bladder function.
- Experience you can count on: She has been in practice since 2013 and performs 400 to 600 surgeries a year, more than 5,000 procedures over her career.
- A teacher at heart: As “Ladyspinedoc,” she is known for explaining brain and spine conditions clearly. You’ll leave your visit understanding your imaging and every option in front of you.
What to Expect
Before surgery
You’ll meet with Dr. Grunch or one of her physician assistants to review your CT or MRI, your symptoms and your goals, and to decide together whether syrinx surgery is right for you. Our team will coordinate pre-operative testing, review your medications (including blood thinners you may need to pause) and walk you through the day of surgery. You’ll have an MRI of the brain and spine to look for the cause of the syrinx.
Procedure day
Surgery usually takes two to four hours. Most patients stay in the hospital for two to four days.
Recovery timeline
- First days: Getting up to walk, sometimes after a day or two lying flat.
- Two weeks: Stitches or staples are removed.
- Four to six weeks: A follow-up visit. Many people return to desk work around this time.
- Three to six months: A follow-up MRI shows whether the syrinx has shrunk. Symptoms often stabilize first and may improve over many months.
Caring for yourself at home
- Your incision: If it is closed with skin glue, you may shower the day after surgery; if it has stitches or staples, wait three days. Pat it dry and don’t use ointments or creams. Don’t soak in a bath, hot tub or pool for six weeks. Stitches or staples are usually removed in 10 to 14 days.
- Activity: Walk several times a day. Avoid bending, twisting, straining and lifting more than 10 pounds for about four to six weeks.
- Lying flat: Because the covering of the spinal cord is opened and sewn closed, you may be asked to lie flat for the first day or two to protect the repair.
- Medications: Take pain medication with food, avoid alcohol while taking it and use a daily stool softener so you don’t strain. Don’t restart blood thinners until Dr. Grunch’s team tells you it’s safe.
- Driving: You may drive once you are off narcotic pain medication and can turn and react comfortably.
Call the office at 470-293-9800 if you have a fever over 101°F, redness, swelling or drainage from the incision, clear fluid leaking from the incision, a headache that is worse when you sit or stand, or calf pain or swelling. Call 911 for new weakness or numbness, loss of bladder or bowel control, chest pain or shortness of breath.
Download your patient instructions
Your instructions depend on the type of surgery you have. Our team will give you written instructions before you go home, and you’ll find other patient sheets on our Patient Resources page.
Frequently Asked Questions
What causes a syrinx?
Most often a Chiari malformation. Others include scarring after a spinal cord injury or infection, a tethered cord and spinal cord tumors. Sometimes no cause is found.
Will the syrinx go away?
Many syrinxes shrink once the cause is treated. They don’t always disappear completely, but stopping them from growing is the main goal.
Will my symptoms improve?
Surgery is most likely to stop symptoms from getting worse. Pain, numbness and weakness can improve, especially when they haven’t been present for long.
Does a small syrinx need surgery?
Often not. Small syrinxes that aren’t causing symptoms are usually watched with MRI scans.
Can a syrinx come back?
It can, which is why follow-up MRI scans are important.
Take the Next Step
If you’ve been told you have a syrinx, you don’t have to navigate it alone. Whether you need a diagnosis, a treatment plan or a second opinion, Dr. Grunch and the Southern Neurosurgery team are here to help you understand your options.
Call 470-293-9800 to schedule an appointment or contact us online.
Have a question first? Ask our virtual assistant anything, 24/7.
We see patients across metro Atlanta and North Georgia at our offices in Gainesville, Sandy Springs and South Atlanta (Riverdale). Find the office nearest you.
Related pages: Syringomyelia · Chiari malformation · Chiari decompression · Tethered cord release · Spinal cord tumor resection
This page is for educational purposes only and is not medical advice. It does not replace individualized care from a licensed physician. If you have sudden weakness, numbness, loss of bladder or bowel control, or a sudden severe headache, call 911 or go to the nearest emergency room.