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View Full Version : Focal myelomalacia at C4-C5 what now??


Redman440
09-17-2015, 08:06 AM
I have recently had a MRI see below and Focal myelomalacia showed up. Looking at the definition of Myelomalacia I am worried. Should I be?? ANY INSIGHT IS REALLY APPRECIATED.:angel:


History: Left arm numbness. Prior cervical spine surgery.

Technique: MR imaging of the cervical spine was obtained on a 1.5 Tesla magnet.
Sagittal T1-weighted, T2-weighted, and inversion recovery imaging is followed
by axial T1 and T2-weighted imaging. After injecting 10 cc of Gadavist, both
sagittal and axial T1-weighted imaging was repeated.

Comment: This is compared to a CT study dated 6/4/2015. The C2-C3 disc level is
unremarkable. No disc bulging, disc herniation, or central spinal stenosis and
foramina are patent.

At C3-C4 there is prominent disc narrowing. There is retrolisthesis with
posterior spurring and disc bulging. This causes central spinal stenosis,
obliterating the CSF in the thecal sac and this mildly compressing the anterior
aspect of the cervical cord. Also, there is very slight hyperintensity in the
cord that is best seen on the inversion recovery sequence and can represent
very minimal edema. There is associated uncovertebral joint spurring and
foraminal narrowing is moderate on the right and mild to moderate on the left.

Better seen on the CT study is associated hardware related to anterior cervical
discectomy and interbody fusion at C4-5 and C5-6. There is anterior plate and
screws causing signal void on the present MRI. Interbody bone grafts cause low
signal on this MRI. There is no bony central spinal stenosis at C4-5 or C5-6.
At C4-C5 there is mild foraminal narrowing bilaterally with mild left-sided
foraminal narrowing at C5-6.

At C6-C7 there is mild disc bulging that slightly thins the anterior thecal sac
but there is no cord compression or displacement. While there appears to be
mild foraminal narrowing on MRI, earlier CT study demonstrated no evidence of
bony foraminal narrowing.

At C7-T1 there is left-sided foraminal narrowing which can be moderate in
degree. This can be correlated with any symptoms referrable to left C8 nerve
root.

There is a small area of focal myelomalacia at the C4-C5 disc level which can
be related to prior stenosis. Remaining cervical spinal cord is normal caliber
and signal intensity. Cerebellar tonsils are in normal position. No intraspinal
mass.

Vertebrae demonstrate normal marrow signal. After gadolinium injection, there
is no pathologic enhancement within the spinal cord.
Impression
Impression:
1. Central spinal stenosis at C3-C4 related to posterior spurring and disc
bulging with retrolisthesis. There is mild flattening of the anterior cervical
cord. There can be very minimal T2 hyperintensity in the cord.
2. Postsurgical changes at C4-5 and C5-6 with no central spinal stenosis or
significant foraminal narrowing.
3. Mild disc bulging at C6-C7 without cord compression. Moderate left foraminal
narrowing at C7-T1. Focal myelomalacia at C4-C5.

teteri66
09-18-2015, 11:19 AM
Welcome to the board. While the myelomalacia is something to keep an eye on, it is confined to a small area at C4-5, and appears to only be in this one spot. Perhaps it is something that occurred during surgery or as a result of surgery.

Of perhaps more concern are all the degenerative changes at C3-4 that are causing stenosis in the central canal, as well as other issues that probably need to be investigated further. Specifically I would ask the doctor about the severity of the central canal stenosis that is "obliterating the CSF in the thecal sac...."

Since the report indicates this results in the cord being mildly compressed, I would assume it is not cause for alarm, but I would think you would want to know more about it and what all the changes at C3-4 mean. (The scale is minimal, mild, moderate, severe).