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welch3 02-17-2012 11:54 PM

understanding my myelogram Please Help
I had neck surgery in 2008 after not totally fusing in over a year, I had a cervical myelogram w/ct scan and was diagnosed with OPLL plus disc issues and was told I had a spine like an old person and I am in my 40's, with Disc Degenerative Disease. I had a second surgery in 2009 so between the two surgeries I had anterior corpectomy of the C5-C7 vertebral bodies. Metallic cage (strut) is in place plate and screws of the C4 and T1 vertebral bodies. Posterior fusion transverse pins through the spinous processes of C4-T1 which are connected by a single metallic suture.

About 6 months ago I started having a lot of BURNING in the middle of my spine, and would have tingling/numbing going from the right of my spine towards my right shoulder. This would be periodic, now it is constant. I have had lower back pain that would radiate to my hip but has become quite frequent and very painful, so went back to my neurosurgeon (was supposed to go back yearly because of the OPLL) but didn't..... he ordered a complete Myelogram this time. I would like some help understanding my report. I go for my follow up but like to have some understanding before my appointment.

"At the T8-T9 level, there is a small left paracentral disc protrusion. This extends from about 1:00 to 230. There is only mild effacement of the thecal sac.
L1-L2, L2-L3, Mild Facet hypertrophy and arthropathy are present

L3-L4 level, there is a mild anterior extradural defect upon the thecal sac. Axial images show mild bulging of the annulus fibrosis. Mild facet hypertrophy and arthropathy are present, and there is the thickening of the ligamentum flavum.

L4-L5 level, a mild anterior extradural defect is present upon the thecal sac. Axial images show moderate diffuse bulging of the annulus fibrosis and a small central disc protrusion. Mild bilateral posterior lateral extradual defects are present due to facet hypertrophy and arthropathy, and thickening of the ligament flavum.

L5-S1 Mild facet hypertrophy and arthropathy are present."

Could someone give me a little understanding?

jennybyc 02-19-2012 03:33 PM

Re: understanding my myelogram Please Help
Hi...we usually deal with MRI's here but I supposed the myelogram is similar.

At have a small disk bulge(I suspect the clock numbers are to say that it looks to be from 1-2:30 if straight back is 12noon)and it is touching the thecal sac. since you have similar problems in the lumbar, let me explain the thecal sac to you.

You know the spinal cord goes down through the spinal canal inside the vertebrae. Since it is made up of the same material as the brain, it is also bathed in spinal fluid, like the brain. What holds the fluid in around the cord is the thecal sac. In the thoracic spine, the canal is circular(val in the cervical)and so the thecal sac takes up about 1-2mms. all the way around the cord. You have a disk bulge that is indenting the thecal sac but not touching the cord. This normally does not cause any pain anywhere. but there is nothing saying if this disk bulge is also hitting the spinal nerves that exit from the cord and go out to the body...that is the pain makers of the spine...not the cord. If it were hitting your cord, you might have numbness in your toes or difficulty walking but not pain. Like the brain that feels no pain itself, the cord feels no pain either.

So in the lumbar, you have similar problems with something hitting the thecal sac. But the lumbar area is different. The true spinal cord stops around T12 to L1 and the remaining nerves that go to the legs hang loosely inside the sac from their on down. So even if something touches the sac, it may never bother those remaining nerves as they far more room to move away form any indentation. The thecal sac actually terminates about S3.

Hypertrophy and arthropathy of the facet joints means you have arthritis of the facet joints, the side joints that stabilize the back when we twist. Painful but not surgical.

And the ligamentum flavum is the ligament that holds the canal together and it can thicken with age and cause a further narrowing of the spinal canal.

The facet arthritis can be treated with epidural injections or radio frequency ablation of the nerves inside the joints. Thickening of the ligament is not something that can be treated but there is no measurement indicating it is a big problem. Ans as with the thoracic, the "defect" hitting the thecal sac should not be causing any problems at all.

I suspect you need an MRI to find out if any of those "defects" are hitting the spinal nerves and giving you pain. The spinal nerves are true nerves and hurt badly when compressed by anything.

Hope this helps.............Jenny

teteri66 02-20-2012 09:38 AM

Re: understanding my myelogram Please Help
Welcome to the board.

Did you have a MRI or a myelogram? A myelogram involves the injection of dye into the sub-arachnoid space in the spine and then a CT scan is done. This report reads like a MRI.

I've had 3 lumbar surgeries but my surgeon doesn't believe in giving patients myelograms, so I have avoided the I may be incorrect in thinking this report is not indicative of a mylogram finding...if so, sorry!

Jenny has pretty much covered the report. The lumbar report supports what the doctor told you earlier...that there are degenerative changes going on in the lumbar area...but, the good news is that everything is described as "mild." This means that conservative measures will be used to treat your symptoms, and that surgery is not warranted at this time.

Most of your problems are coming from the facet joints, which are showing signs of arthritic changes. And at the L3-L4 the ligamentum flavum is thickening. This is probably the spinal segment that is causing you the most pain, as there is also a slight problem with the disc at this level, too.
These issues combine to take up space in the central canal, which can result in a spinal nerve becoming compressed.

Jenny is correct that there is more room in the canal at this lumbar level than at the higher up levels, but any narrowing can still result in spinal stenosis when "things" are impinging on the thecal sac.

Do you have pain on the front or side of your thigh?

jennybyc 02-20-2012 11:11 AM

Re: understanding my myelogram Please Help
Hi Teri...thanks for coming to my aid.....I'm more neck than back. And you're right...this does read like an MRI, not a myelogram so I'm just guessing the wording means the same thing. But I find it curious that there is nothing about the foramina...maybe that is indicative of a myelogram?

Thanks for your help...I need it..............Jenny

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