I didn't know how to name this thread, so I used the word "rules" for it. But here is a question I simply can't find the answer to.
With how much central canal stenosis will you get in trouble?
I have congenital cervical spinal stenosis and had a laminectomy done on C5-C6 partial C7, although the latest surgeon couldn't see there has been work done on C7.
2 neurosurgeons from different hospitals looked at my latest MRI from oct 2012. Both say there is enough room at the moment, but the first one said there is a large narrowing at C7. If I look at the MRI i can see only just a little bit of spinal fluid on the left and a really tiny / almost nothing on the right on that level.
Here is the thing. Both neurosurgeons say "When there is spinal fluid around the cord you won't get in trouble".
But is this really true? I saw a few cases on websites where there was spinal fluid around the cord but still there was myelopathy due to spinal stenosis.
So that's why I am wondering, what is the rule? Am I safe as long as there is spinal fluid around my cord?
I don't want to risk more myelopathy on my cord and I'm only 32 and will probably look at some more spinal trouble on the way.
I know some use the amount of mm as a grade. But there is nothing to be found in the notes of my MRI cd with that. Guess they don't do that in Holland.
Also both surgeons say a follow up MRI isn't necessary because they won't operate anyway unless I lose more strength or sensation. But this loss will be permanent. So can someone explain to me why doing a checkup MRI every certain period of time isn't a better option then to wait for loss of strength / sensation?
The rules are not hard and fast, but up to interpretation by your doc when they compare MRI results with your symptoms and other tests such as nerve conduction. No one test can determine what needs to be done.
But you have some incorrect info.. the signs of cord compression from spinal stenosis are reversible if caught and the cord allowed to expand back to a reasonable size. I've been through cord compression in my cervical, thoracic and lumbar spine and surgery has relieved the compression and I got back most of the feeling and all of the strength. And I have cord compression again in my neck after having it relieved twice before.
Seeing spinal fluid around the cord does help them to know you are okay. But when there is frank compression of the cord, that is when they start to measure the cord width. Since the pressure is done so slowly over a period of many years, we can take more cord compression than someone who has had it happen abruptly such as in breaking one's neck or dislocating a vertebrae suddenly. The cord averages 11-12mms in width. I personally had compression down to 5-6 mms at more than 1 level in my neck and it was 7-8mms. in the remaining levels...from C3 to C7. Others here have similar stories.
So you have a good way to go before you will need surgery. I opted to have a laminoplasty that opens the back of the spinal canal and re-builds it to double the size of the canal, yet continue to protect the cord with bone. You may need the same thing down the road.
So as far as rules go...it's not just how many millimeters or that you have numbness in your feet or that your reflexes are hyper or hypo, indicating nerve compromise, but all of them together. The MRI can show the cord width and that is important but not the be all and end all of cord analysis. I recently was operated on for cauda equine syndrome from lumbar compression. The MRI said I didn't have it. The nerve studies said I had something more wrong than the MRI showed. When the surgeon got in there, he was blown away as to how bad it really was and my symptoms were correct for what was really wrong. BTW, everything came back.
So it is all of it and no one study or symptom rules the diagnosis or what needs to be done to manage or correct it.
The Following User Says Thank You to eggyby For This Useful Post: rv80 (01-22-2013)
Hi Jen, sorry for the late reply. Thanks a lot for your detailed answer to my question! I didn't know the signs were reversible. When I got my first MRI it showed a white lesion on my cord which is myelopathy and all the surgeons told me that was permanent. This was right after I got my first symptoms. It's great to read you have gotten so many back even after those compressions!
It's hard to catch the symptoms nowadays since I already have permanent myelopathy to the spinal cord so I always have numbness on and off and always have high reflexes in arms and legs.
I also checked the mm of the cord in width in the top down view of my mri and could see that on all levels in my neck the cord is around 11 or 12 mm but the height difference is something else. That varies a lot. In the sideview of the mri the width of the cord seems completely different while there is a legend on the side with the sizes.
It's always kind of scary to look at my mri with a "normal" one to compare it width to see what's considered healthy.