Bob VogelQ. In March 2006 I became a T5 incomplete para from a motorcycle accident. A year later I started having numbness and “burning pins and needles” pain in my arms. By September 2007 the pain and numbness had gotten much worse. An MRI confirmed I had an elongated syrinx that went above and below T5. I underwent surgery and had a shunt put in, and the shunt relieved the pain and numbness. But this summer the burning pins and needles returned and got worse over time. I also developed a pressure sore that required hospitalization. A follow-up MRI confirmed that I had had a syrinx but the shunt had cleared it up. Now I’m wondering if the surgeon should have de-tethered my spinal cord as well.
— Dave, Loganville, Georgia

A. Dave, this is a complicated subject. Approximately 15 percent of people with SCI develop symptoms from spinal cord tethering or tethering with a syrinx that require surgical intervention. In the United States there are only two neurosurgeons at major rehab centers who specialize in performing surgery on tethered spinal cords and syrinxes — Dr. Barth Green at the University of Miami School of Medicine and Dr. Scott Falci at Craig Hospital in Denver.

According to Falci, who has performed over 1,000 surgeries on syrinxes and tethered spinal cords, a traumatic injury to the spinal cord causes scarring and tethering. A normal spinal cord moves back and forth a couple of millimeters with each heartbeat. It also moves in the spinal canal with body movement. With scarring, normal movement is impeded (the cord becomes tethered). The scarring also interrupts normal flow of spinal fluid around the cord. This may cause a breakdown in cell structure and spinal fluid will seep into the cord, resulting in softening of the spinal cord (myelomalacia). If enough fluid seeps in, a cyst or cavity may form (syrinx).

It is possible to have a syrinx but no symptoms. “The symptoms drive us to do the surgery,” Falci says. “I have heard people say, ‘I’ve had a huge syrinx on my cord for 20 years and the doc says if I don’t get it treated, I’m going to stop breathing and die.’ I tell them that’s not