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  • MRI translation. 24/7 Pain and depressed... Is this myelomelacia? MRI

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    Old 10-27-2014, 12:53 PM   #1
    JohnnyFL
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    MRI translation. 24/7 Pain and depressed... Is this myelomelacia? MRI

    Hello everyone,

    I've been through the ringer with injuries in my life. I've been in several severe car accidents, with no apparent immediate damage at the time of the accidents. Also, been lifting heavy for about 10 years and a few minor injuries here and there - including my shoulder and wrist. However, I really hurt my back doing bentover rows with wayyyyy to much weight and over the last 2 years my bak has been unbearable with pain. I continued to play volleyball, and it seems like a new injury pops up every week. Now, by wrist burns, knee hurts, shoulder and elbow occasionally hurt, back burns and cramps, and several joints hurt.

    I've been to a rheumatologist and he says its not arthritis. I got an MRI and it mentions myelomalacia and 5 herniated discs. I've seen 2 neuro-surgeons and they say they do not want to operate, and that the radiologist vastly exaggerated the report, whatever thats supposed to mean. I have also had a full workup done with a neurologist (a nerve conductance test) and he says everything is fine. I am a college student and my back is in severe pain, causing me to want to drop out because I am so depressed. I can barely study, cant workout, self-esteem is so low cant talk to girls. I've had an epidural, radiofrequency ablasion, and physical therapy and NOTHING is working. I am desperate. Please help me understand my MRI so that I may find a solution.Thanks so much!



    ***********MRI:
    Reason For Exam: Patient has back pain from cervical to lumbar and hip area, with shoulder pain, arm pain and leg pain. Hx of lumbar herniated. Need to evaluation of spine abnormalities.
    Ordering Diagnosis: Pain in elbow joint, unspecified laterality<br />Wrist pain, unspecified laterality<br />Back pain

    HISTORY: Multiple joint pain. The patient has back pain from ceverical to lumbar and hip area, with shoulder pain, arm pain and leg pain.

    EXAM: MR THORACIC SPINE NO IVCON, MR LUMBAR SPINE NO IVCON, MR CERVICAL SPINE NO IVCON.

    FINDINGS:
    Cervical spine:
    The alignment is normal. The anatomic relationship between the dens, the anterior arch of C1, and the foramen magnum is unremarkable. There is mild multilevel disc desiccation. Otherwise, the disc space heights and vertebral body heights are preserved. The marrow signal is within the normal limits for the patientís chronological age. The cord signal is within the normal limits. The visualized posterior fossa is unremarkable. There is no significant foraminal or canal narrowing. The prevertebral soft tissues are within the normal limits.

    Thoracic spine:
    The alignment is normal. There is multilevel disc desiccation in the mid thoracic spine. The vertebral body heights are within the normal limits. The marrow signal is within the normal limits for the patientís chronological age. There is no abnormal cord signal.

    There is a focal central disc protrusion at T5-T6 causing mass effect on the cord anteriorly with a punctate focus of increased T2 signal in the cord, representing myelomalacia.

    There is a focal central disc extrusion at T6-T7 causing mass effect on the cord anteriorly without abnormal cord signal.

    There is a broad based left of central disc protrusion at T10-T11 causing mass effect on the cord anteriorly on the left side without abnormal cord signal.

    Otherwise, there is no significant canal or foraminal narrowing.

    Lumbar Spine:
    The alignment is normal. There is disc desiccation at L5-S1 with disc protrusion. The vertebral body heights are within the normal limits. The marrow signals are within the normal limits for the patientís chronological age. The conus medullaris terminates at L1. The visualized distal cord demonstrates no abnormal cord signal. There is multilevel facet arthropathy in the lower lumbar spine.
    L4-L5: There is R>L disc bulge and bilateral facet arthropathy with facet joint effusion and causing mild right foraminal narrowing. There is no significant canal narrowing.

    L5-S1: There is central and R>L paracentral disc protrusion contacting the exiting right S1 nerve root. There is no significant canal or foraminal narrowing.

    IMPRESSION:
    Mild degenerative disease of the cervical spine without significant canal or foraminal narrowing.

    Multilevel degenerative disease of the thoracic spine with disc protrusions/extrusion at T5-T6, T6-T7, and T10-T11 causing mass effect on the cord with a punctate focus if increased T2 signal in the cord at T5, suggesting myelomalacia.

    Multilevel degenerative disease in the lower lumbar spine with disc protrusion at L5-S1 contacting the exiting right S1 nerve root. There is also mild right-sided foraminal narrowing at L4-L5 with bilateral facet arthropathy with joint effusion.

    ACUITY RANK: 3. Priority.

     
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    Old 10-31-2014, 08:42 PM   #2
    teteri66
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    Re: MRI translation. 24/7 Pain and depressed... Is this myelomelacia? MRI

    Welcome to the board. You have a complicated history that merits the attention of a good spine specialist. Since you have seen neurosurgeons in the past, I would suggest a consult with a fellowship-trained orthopedic spine surgeon...not a general ortho surgeon....

    First of all perhaps when the rheumatologist said "no arthritis" he was speaking in general terms. We all develop some arthritic changes in our spines as we age. Since you have been involved in what I assume were car crashes involving high impact, we can assume that you are primed to develop arthritis in the spine sooner than "normal."

    I suspect that due to your age, you are being told that you don't need surgery, etc. What you have are minimal issues at almost every level of the spine.
    The mild multilevel disc dessication means that the discs are in the first stage of a degenerative process. Discs are comprised of mostly "water," and as we age, they begin to dry out. This eventually causes the disc to flatten, bringing the vertebrae closer together.

    This happens due to aging, but it can happen sooner when there is injury or repetitious stress to the spine.

    Since this is reported to be "mild," it would mean it is just in the beginning stages and nothing a doctor would be concerned about. In the cervical area, this dessication is not irritating or compressing any spinal nerves.

    There is a bit more going on in the middle of the spine. This is where there are three discs that are in varying stages of herniation, including the one at T5-6, which is suspected of causing some myelomacia. It appears they are pressing into the spinal cord, but not enough to cause compression or loss of cord signal.

    In the lumbar spine, there is more disc dessication and facet arthropathy at many levels...the facet arthropathy are arthritic changes that usually go hand in glove with the degenerative changes of the discs. As the discs flatten, the joints tend to enlarge in an attempt to keep the spine stable. If it increases in size too much, a spinal nerve ends up getting compressed. At L5-S1 the herniated disc is pushing into the S1 nerve on the right side.

    It sounds to me like your spine was impacted by the crashes, and that, due to your active lifestyle, it has been continually aggravated. There is no one issue that sends up a red flag, where the doctor could point to it and say "This is the cause of your pain!" This doesn't mean that you aren't in a lot of pain. It just men's that there is nothing big to jump out, something that would require surgery.

    However, the neurosurgeon should have provided a plan of treatment for you and an accurate diagnosis. Conservative treatment options would include things like a course of physical therapy, oral medications, perhaps a series of steroid injections, etc. When the entire spine has issues, sometimes doctors aren't quite sure where to begin treatment.

    You might benefit from an alternate therapy type person who does body work.
    Have you ever stopped all your activities and given your spine a chance to heal up? I would think that volleyball is very hard on your back, with the jumping, twisting, etc. and lifting weights is probably not helpful when you have bad discs....

     
    Old 11-02-2014, 04:57 PM   #3
    JohnnyFL
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    Re: MRI translation. 24/7 Pain and depressed... Is this myelomelacia? MRI

    Teteri66, thank you for taking the time for such an elaborate response I appreciate it.

    Quote:
    "This is where there are three discs that are in varying stages of herniation, including the one at T5-6, which is suspected of causing some myelomacia. It appears they are pressing into the spinal cord, but not enough to cause compression or loss of cord signal."
    ^The kind of myelomalacia that can cause paralysis of the legs? I am just so terrified I will not be able to exercise, travel, have sex (excuse my bluntness), and follow my ambitions like a normal 28 year old.

    Quote:
    "At L5-S1 the herniated disc is pushing into the S1 nerve on the right side."
    ^I believe the car accidents did a lot of damage, but the weightlifting injury that really aggravated it and caused the initial "agonizing pain" is the one that caused the lumbar herniation I believe. At first, I was having shooting sciatica into my right leg and into my heel. It went away. Then, 2 months ago, I was playing volleyball and my knee started burning and hasnt went away since. I had an MRI of my knee and nothing is awry. Do you think the pain is related to the lumbar and, if so, would a discectomy help it?

    Quote:
    "However, the neurosurgeon should have provided a plan of treatment for you and an accurate diagnosis. Conservative treatment options would include things like a course of physical therapy, oral medications, perhaps a series of steroid injections, etc. When the entire spine has issues, sometimes doctors aren't quite sure where to begin treatment."
    ^ I had one steroid injection into my lumbar and it did nothing. I've been doing physical therapy for more than a year and it mildly, mildly helps. I still can't sit or ride in a car for more than a few minutes without pain. I've had one lumbar nerve ablation and it helped, for only 2 weeks, and am set up for a thoracic ablation in a few weeks. As far as medication, I've tried nortryptaline and, while fantastic for pain, dulls my intelligence and makes me irritable. I won't accept those types of personality changes (lose my friends, fail school) to be painless.

    Quote:
    You might benefit from an alternate therapy type person who does body work.
    Have you ever stopped all your activities and given your spine a chance to heal up? I would think that volleyball is very hard on your back, with the jumping, twisting, etc. and lifting weights is probably not helpful when you have bad discs....
    What types of alternative therapy did you have in mind? I have stopped weightlifting and lost almost 30 pounds of muscle and gained quite a bit of fat (a real confidence killer haha). As far as volleyball, my friend just asked me to play yesterday and I declined. Its been almost 2 months since I've played.

    I will not accept this injury to control and limit my life in the future, but I am willing to forfeit these things now for the sake of my future. If you can, please address my questions. Thanks so much!

     
    Old 11-07-2014, 10:17 PM   #4
    powergrub
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    Re: MRI translation. 24/7 Pain and depressed... Is this myelomelacia? MRI

    It looks like you would benefit from seeing a pain management specialist. They may offer other pain meds that take down swelling and nerve pain like Gabapentin and Lyrica, possibly Neurontin.

    I have had over 60 lumbar epidurals throughout my life with no effect and two years ago had my first caudal epidural which is a bit lower in the spine than the lumbar epidural. I could not believe the pain relief. It has lasted a long time. I do them up to three times a year and it is better than taking narcotics or any oral pain meds.

    I also think you should seek a second opinion about your entire case.

    I had my legs muscles and arm muscles contract up after a heavy workout in 2010and my bowels stopped functioning and it got to the point that I could not straighten out my leg or my arms. I work out everyday at a high intensity and work part time so I am tuned into my body especially when something goes terribly wrong.

    It took three years and many doctors to finally get to a neurosurgeon who said I needed immediate surgery to decompress my spinal cord. After the surgery it was like a miracle.

    My point is that you should have at least a few more doctors look at your MRI and give you feedback. Tell them you are in constant pain and looking for a second opinion on what can or cannot be done or a plan for long term pain management and especially get information on the myelomalacia.

    Many times one doctor says one thing and another doctor says something completely different. That is why having three opinions is the best.

    Be your own advocate, no one else is going to stand up for you and make sure you are safe and that your spinal cord is stable. You have real concerns for a male in their 20s and I would want to know what the prognosis is regarding the thoracic spine issues you are dealing with.

    Do not take the opinion of just one doctor if you are still having lots of pain and concerns. On the other hand, sometimes you have to make the choice between pain relief with certain drugs and side effects (usually the side effects lessen in a few months time) and no pain relief and learning to live with the pain.

    Most doctors do not want to operate on someone so young when the spine problems do not appear severe. This does not mean that you are not experiencing severe pain. There is only so much that can be "measured" in medicine.

    Please seek some more opinions and get with a pain management team that you trust for continued care and other types of pain relief.

    Stay as active as possible regardless of the pain if your doctors say you can exercise and you might look into meditation exercises. I was really against this at first but I stuck with it and it also changed my life for the better. I also use a foam roller daily for myofascial muscle release. This is awesome, like having a massage whenever you want one each day and it keeps my muscles loose.

    Keep us posted.

     
    Old 11-08-2014, 05:40 AM   #5
    teteri66
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    Re: MRI translation. 24/7 Pain and depressed... Is this myelomelacia? MRI

    How old were you at the time of the auto accidents? Would they be considered "high impact?"

     
    Old 11-08-2014, 07:13 PM   #6
    JohnnyFL
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    Re: MRI translation. 24/7 Pain and depressed... Is this myelomelacia? MRI

    Teteri66, I saw a fellowship trained orthopedic surgeon, as you suggested, a few days ago. He was much more down-to-earth than the neurosurgeons and spent a bit more time with me. The neurosurgeons basically said, "sorry, nothing we can do. We don't want to operate."

    The orthopedic surgeon made a few suggestions. He believes that since in my thoracic spine there is nothing MECHANICALLY wrong other than some arthritis and drying of discs, surgery would do nothing to help and that most of the pain there should resolve on its own over time. HOWEVER, because the herniated disc at L5-S1 is jutting into my nerve it could be causing my lower back/leg/knee pain. He wants me to get a selective nerve root injection into the L5-S1 and, if that doesn't work, try a transforaminal injection there followed by microdiscetomy if successful.

    I am just worried holding off on surgery may cause permanent nerve damage. Is this a valid concern? How do these suggestions sound? In the meantime, while waiting for my thoracic pain to resolve on its own, I'm scheduled for a thoracic nerve ablation next week. I'll keep you posted.

    Quote:
    How old were you at the time of the auto accidents? Would they be considered "high impact?"
    My first auto accident was at 17. I crashed headfirst into another car going 40 mph; both cars were totaled. In my second car accident, I was 19 and my friend was driving and he lost control on a wet road and we flipped 6-7 times. I was dragged out of the car (unconscious) and woke up in the hospital with 200 stitches in my face and a catheter. In my third car accident, I was 20 and I hit two cars that were stopped in the middle of the road going 50 mph. I sustained minor injuries.

    I'm 100% positive that these high-impact car accidents had something to do with my back issues, however my pain has been relatively pain-free for 6 years after my last car accident. It was after my weight-lifting injury 2 years ago that the significant pain started and when the cookie really began to crumble.


    @powergrub
    Quote:
    It took three years and many doctors to finally get to a neurosurgeon who said I needed immediate surgery to decompress my spinal cord. After the surgery it was like a miracle.
    What procedures were performed?

    I worked out with some light weights today and felt great after my workout - until I gave up studying after a few hours due to the pain. But, I will continue to train regardless. The pain is relentless. I was once a 4.0 engineering student but, this semester, the pain has caused me to truly not care. Just last semester I had dreams of Stanford and the gpa to get me there. Pain is a devastating beast isnt it?

    Last edited by JohnnyFL; 11-08-2014 at 07:19 PM.

     
    Old 11-16-2014, 12:53 PM   #7
    Aleosha
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    Re: MRI translation. 24/7 Pain and depressed... Is this myelomelacia? MRI

    I am so happy to have found this thread! Early in September, I started having a pain in my neck, radiating into my shoulder and arm. I went to see an orthopedic specialist who gave me a steroid shot in the shoulder, although the x-ray of the shoulder showed nothing wrong. It seemed that the shot helped for a week or so and then the pain was back, and slowly kept getting worse until it became debilitating. I went back to the same doctor who sent me to have an MRI. The result? Only mild inflammation, which should not have caused that much pain.

    I went back to that office and they did an x-ray of the neck because I kept complaining that my neck also hurts. A lot. Well, the x-ray showed NOTHING but since I kept calling the doctor and complaining, they sent me to have an MRI of the neck. Here's what it says:

    **************************************** ********
    There is mild to moderate narrowing of the C5-C6 and C6-C7 disc spaces.

    There is a combination of posterior disc bulge and posterior osteophyte formation at C4-C5, C5-C6, and C6-C7 levels. There is moderate narrowing of the C5-C6 neural foramina bilaterally, more pronounced on the right than the left, secondary to the disc/spur combination. There is no evidence of focal disc herniation.
    **************************************** ********

    I have YET to hear back from the office on what to do next. I've called them 5 times over last week and no one has any answers. I'm really shocked that after treating my shoulder instead of my neck they just refuse to even answer questions about the test.

    I would assume that the severe, absurd, constant pain I've been feeling for months now is caused by the neck problems and not the mild inflammation of the shoulder tendon.
    But what do I know?

    Last edited by Aleosha; 11-16-2014 at 12:56 PM.

     
    Old 12-19-2014, 06:15 PM   #8
    JohnUF
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    Re: MRI translation. 24/7 Pain and depressed... Is this myelomelacia? MRI

    Quote:
    Originally Posted by Aleosha View Post
    I am so happy to have found this thread! Early in September, I started having a pain in my neck, radiating into my shoulder and arm. I went to see an orthopedic specialist who gave me a steroid shot in the shoulder, although the x-ray of the shoulder showed nothing wrong. It seemed that the shot helped for a week or so and then the pain was back, and slowly kept getting worse until it became debilitating. I went back to the same doctor who sent me to have an MRI. The result? Only mild inflammation, which should not have caused that much pain.

    I went back to that office and they did an x-ray of the neck because I kept complaining that my neck also hurts. A lot. Well, the x-ray showed NOTHING but since I kept calling the doctor and complaining, they sent me to have an MRI of the neck. Here's what it says:

    **************************************** ********
    There is mild to moderate narrowing of the C5-C6 and C6-C7 disc spaces.

    There is a combination of posterior disc bulge and posterior osteophyte formation at C4-C5, C5-C6, and C6-C7 levels. There is moderate narrowing of the C5-C6 neural foramina bilaterally, more pronounced on the right than the left, secondary to the disc/spur combination. There is no evidence of focal disc herniation.
    **************************************** ********

    I have YET to hear back from the office on what to do next. I've called them 5 times over last week and no one has any answers. I'm really shocked that after treating my shoulder instead of my neck they just refuse to even answer questions about the test.

    I would assume that the severe, absurd, constant pain I've been feeling for months now is caused by the neck problems and not the mild inflammation of the shoulder tendon.
    But what do I know?

    You need to see a different orthopedic surgeon.

     
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