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  • New MRI: early myelomalacia?

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    Old 10-14-2016, 08:49 PM   #1
    Plates
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    New MRI: early myelomalacia?

    I would love if someone could talk to me about this. I have been trying to get in to see a neurosurgeon, but it is taking forever. First, my MRI wasn't clear enough as I was in so much pain that I couldn't lay still for such a long time. He requested a sedated MRI which I now have. I'm just impatiently waiting on him to schedule an appointment now.

    I'm terrified as this sounds serious. I've had severe neck pain for years. Numbness in my little fingers. I can't lift my legs at all while laying flat. Walking has become more difficult as my legs feel heavy. I start having lots of,pain when I walk more than a short distance. Stiffness in my neck and bathroom urgency with a feeling that I need to urinate constantly.

    I'm worrying that I have waited too long and nothing can be done about this. Doctors have sent me to PT for years and it never helped and at times seemed impossible for me to do. My big fear is paralysis.

    TECHNICAL INFORMATION: T1, T2 GRE, T2 FSE and STIR sagittal thin sections with T2 GRE and FSE axial sections at selected levels. The procedure was performed utilizing moderate conscious sedation. Due to the patient's severe anxiety/pain, sedation was utilized and the patient was assessed as a good candidate for moderate conscious sedation. An intravenous line was started and a total of 5 mg of Valium were administered. This resulted in satisfactory relaxation and sedation. The patient was monitored with a NIBP monitor including cardiac, pulse and oxygen saturation. These values remained within normal ranges throughout the procedure. Total intraservice (sedation) time was 30 minutes.
    COMPARISON/CORRELATION: CT cervical spine 10/10/2016. Prior imaging requested, not yet available.
    INTERPRETATION:
    Alignment: Normal cervical lordosis.
    Osseous Structures: No acute fracture or osseous destructive lesion. No marrow signal abnormality.
    Cord: Subtle area of cord signal abnormality just below C5-6.
    T3-4 through T1-2: Normal dorsal disc and facet morphology. No stenosis or impingement.
    C7-T1: Mild disc degeneration, dorsal annular bulge without stenosis or impingement. Normal facet morphology. Patent foramina.
    C6-7: Moderate disc degeneration, retrolisthesis, dorsal annular bulge causing moderate central canal stenosis with ventral impingement. Mild left facet degeneration. Severe right, moderate-severe left foraminal stenosis.
    C5-6: Moderate disc degeneration, dorsal annular bulge causing moderate-severe central stenosis with impingement. Mild left facet degeneration. Moderate-severe right, severe left foraminal stenosis.
    C4-5: Mild disc degeneration and dorsal annular bulge without central stenosis or impingement. Mild bilateral facet degeneration. Mild right foraminal stenosis.
    C3-4: Mild disc degeneration, retrolisthesis, dorsal annular bulge causing mild central stenosis without impingement. Mild bilateral facet degeneration. Mild right, moderate-severe left foraminal stenosis.
    C2-3: Mild disc degeneration, 2 mm left posterolateral protrusion without central stenosis or impingement. Mild bilateral facet degeneration. Mild bilateral foraminal stenosis.
    Craniovertebral junction: The craniovertebral junction is normal. No abnormality of the visualized brain parenchyma.
    Soft tissues: No abnormality of the soft tissues of the neck.
    CONCLUSION: Multilevel cervical disc and facet degeneration in lordotic alignment with the following specific findings:
    1. C5-6 moderate-severe central stenosis with impingement and subtle focus of cord signal abnormality, edema versus early myelomalacia.
    2. C6-7 moderate central canal stenosis with impingement.
    3. C3-4 mild central canal stenosis without impingement.
    4. Moderate to severe foraminal stenosis bilaterally C6-7, C5-6, right C4-5 and left C3-4.

     
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    Old 10-15-2016, 07:59 AM   #2
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    Re: New MRI: early myelomalacia?

    There are a few general concepts I would like to mention ahead of your appointment that will help you to better understand the doctor's comments. When you go in, the doctor should review the MRI and will probably pay no attention to the report which is written by a radiologist. He should do a physical exam and a basic neurological exam to determine and correlate what he finds with what the MRI indicates. The MRI is just one piece of the diagnostic puzzle and sometimes indicates something is much worse than it turns out to be.

    The cervical spine is different from the lumbar spine in that issues like a herniated disc or stenosis can cause pain that is felt in the neck or along the pathway of the cervical spine. If there is stenosis that affects the central canal, it can cause compression of the spinal cord, which can cause pain at the level of the compression or (this is the significant part!) anywhere BELOW this level. Pain and symptoms do not go upward from the level. In other words, if you have a problem in your lower back, it will not cause numbness in your arm or hand. However, the reverse "can" be true: cervical cord compression can cause leg pain, sexual, bowel or bladder issues, etc.

    Stenosis means "narrowing." There are two primary places where stenosis occurs in the spine. One is in the central canal, where the spinal cord and spinal fluid is contained. The other is in the foramina. The foramen is an opening located at each vertebral level where the spinal nerve exits the spine and goes out to the part of the body the nerve innervates. When the foramen becomes blocked, it puts pressure on the spinal nerve, which can cause symptoms like pain, tingling or numbness. It can be just slightly blocked or it can become almost completely blocked...the radiologist uses specific adjectives to describe "how bad" something is...minimal, mild, moderate and severe. In the case of severe stenosis, if the nerve is not decompressed, it can lead to permanent nerve damage.

    Now to your report....as you can see there are some degenerative changes at a number of levels, but nerve compression is the worst at C5-6 and and C6-7.
    At these two levels there is foraminal stenosis on both left and right sides and the disc is bulging and pushing into the central canal where it is causing moderate to severe stenosis, with some impact on the cord. The doctor will do some neurological testing to see to what extent the bulging discs are pushing into the spinal cord, etc.

    There is some central canal stenosis at other levels too, but does not appear to be impacting the spinal cord.

    To prepare yourself for the appointment you might want to do some reading on
    "Cervical degenerative disc disease." It will help you better understand the degenerative process and help you to have a conversation with your doctor rather than looking blankly at him!

    If there is any sign of myelomalacia it is not obvious from MRI. The doctor will be able to tell you more after looking to the images.

     
    Old 10-15-2016, 10:38 AM   #3
    Plates
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    Re: New MRI: early myelomalacia?

    Thank you for the info. I have been reading and that is why I now know that urgency isn't just a part of the aging process. It could be related to this. I also learned it could make my legs feel heavy and cause me to tire easily and have pain with walking.

    So "edema versus early myelomalacia " on the report means no myelolmacia?

     
    Old 10-16-2016, 11:12 AM   #4
    teteri66
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    Re: New MRI: early myelomalacia?

    Heavy legs is a sign or early symptom of some spinal cord compression. That phrase means the radiologist isn't sure what is being seen...might be some edema, might be some myelomalacia...the spine specialist needs to review the imaging and even order other tests to confirm what it is.

    Bear in mind that most spine specialists do not look at the radiology report. If this edema vs. myelomalacia is not brought up, be prepared to ask about it yourself. It may be that as far as the doctor is concerned, whatever the radiology saw is not that significant in his/her opinion.

     
    Old 10-16-2016, 12:10 PM   #5
    Plates
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    Re: New MRI: early myelomalacia?

    Yes, this neurosurgeon does look at MRIs himself. Thank you for the explanation. Maybe I'll hear from the surgeon tomorrow about this report and further testing.

     
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