[silverfae]

Hello everyone.

I recently had a cervical MRI done by my orthopedic doctor and now that I have the actual report in hand (which I didn't the last time I saw him) It looks kind of scary to me and while I am generally good at looking things up and work in a health care field, I can't seem to find a lot of info on this MRI.

I will start by saying that I have had some degree of neck pain pretty much constantly for the last 8 years. My previous doctor told me that it was fibromyalgia and there was nothing he could do, I just needed to exercise more (I am quite active as it is). In December of last year, I developed pain in my back and legs that was so bad I couldn't even put my own pants and shoes in in the morning. My new PCP sent me to a rheumatologist because my sed rate and CRP were very high, and he said "the fibromyalgia diagnosis stands" and that I had a severe vitamin d deficiency, gave me 12 weeks of vitamin D pills and said he would see me in 4 months. I went back to my PCP and told her I was still in immense pain and that this was not ok, so she ordered an MRI of my lumbar area. This showed a herniated disc putting pressure on the S1 nerve root, as well as disc and facet joint arthritis. I got a steroid shot in the area and lo and behold, the vast majority of the pain was gone.

At the same time I had been complaining because my elbows hurt and my hands were going pins and needles all the time. I was sent to an ortho doc specializing in hands and arms. He said it was bilateral carpal tunnel, plus ulnar nerve irritation and tendonitis and put me in wrist braces for 2 months and told me to come back after that if it was still happening. It was, so I went back and he ordered an EMG - no abnormalities in my wrists or elbows, the neurologist suggested perhaps I had fibromyalgia. So I was then referred to an ortho doc that specialized in spines, and he ordered a cervical MRI. At this time I was also going in for my spine shot, and the pain management doc did a series of reflex tests that the neuro and ortho docs didn't do and found that I have bilateral hyper reflexes in both arms and a positive Hoffman's sign. When I went back to see the orhto doc, he said that there was a lot more damage than he expected to see for someone my age (I am 33) and that he needed me to go back to the neurologist. I am now waiting to see the neurologist again, but I have very little hope that they will say anything other than fibromyalgia now that I have somehow picked up that label (which, by the way, I do not have any of the fibro symptoms other than that I have had pain in 2 areas that has been shown to have a cause on MRI) So, 2 weeks later, I got the actual MRI report and as I said, it is scaring me a bit and I hoped I could get some feedback on it here.

MRI CERVICAL SPINE W/O CONTRAST
INDICATION
A 33-year-old female with neck pain and bilateral hand numbness.
TECHNIQUE
Sagittal T1, T2, inversion recovery, and axial 3D and gradient-echo
T2*, and T1 MR images of the cervical spine. No comparison.
FINDINGS
Cervical alignment and marrow signal are normal. There is cervical
cord abutment and increased T2 signal within the cord from C3
through C5 compatible with cervical myelomalacia secondary to disk
degeneration and ventral abutment as detailed below.
Craniocervical junctional anatomy is unremarkable as is C2-3.
C3-4 has moderate central canal stenosis with a mild posterior disk
bulge abutting and flattening the ventral aspect of the cervical
cord. Uncovertebral spurring encroaches the neural foramina.
C4-5 has moderate posterior osteophyte-disk complex and mild
uncovertebral spurring with ventral abutment, and flattening of the
cervical cord, and moderate central canal stenosis. Neural foramina
are mildly encroached.
C5-6 has mild uncovertebral spurring and mild posterior disk bulge
causing mild central canal stenosis. No cord abutment or
compression.
C6-7 and C7-T1 levels are unremarkable.
Paraspinal soft tissues and musculature are unremarkable.
Visualized posterior fossa is unremarkable. Cerebellar tonsils are
normal in position.
IMPRESSION
Moderate C3-4, C4-5 and to a lesser extent C5-6 degenerative disk
disease. Mild to moderate posterior osteophyte-disk complex and
disk bulging cause moderate central canal stenoses, primarily at C3-
4 and C4-5, with signs of cervical myelomalacia.
I suspect there is underlying degree of short pedicles and
congenital narrowing of the central canal.

xrays also show I have mild kyphosis in my neck.

The most concerning thing for me is the myelomalacia, which I can't seem to find much about on the internet. Is this as bad as it sounds? My ortho doc seemed very unconcerned about the whole thing, but did mention that they would have to surgery at some point to decompress the cord, but didn't sound like it would need to be any time soon.

Thanks!

[mg neck prob]

Hi Silver,

Im sure Lessa with decfier your MRI---is very good at breaking it down in simple terms.

I dont think it looks to bad at this point most concerning is kyphosis can be a sometimes hard to treat but your case is mild. Have your tried ESI(epidural steroid injections) it might help the herinations since they dont seem to be severe one it may help calm down inflamation and allow the disc to heal. I have alot of friends and family acheive success and avoid surgery.

There in minmal procedure called lamintomy & foraminotomy that may hep with the stensis and relief myelomalacia, only if the prob is stemming from the stenosis. Usually done out patient and you home same day very quick and easy recovery for most and might help avoid fusion down the line. I think because your young I would try to be as proactive as possible. Always get 2 or 3 consults when it comes to the spine. Best wishes!!!!!

[Jomar]

Do the drs feel your arm & hand symptoms fit with the MRI results?
If not do you do much repetitive or long time desk work, or had any previous whiplash or other neck injury?

Can you hold your arms up in the stick em up position , open & close hands? Do they get heavy, turn white, pain increased?
If so look at our Thoracic outlet syndrome forum. (TOS) for short.

If you don't have severe fatigue along with whole body aches, I don't think fibro is an issue. Some drs just say that.

We have a Fibro forum as well as a Medications forum - depending on the Vit D pills that were rx'd , they might have been the wrong type and not as usable by the body.
Index of forum topics-
http://neurotalk.psychcentral.com/index.php

[silverfae]

Jo*mar - my ortho doc said that in the absence of thyroid problems or b12 deficiency that the hand symptoms could be related to the MRI findings, but that is why he is sending me to the neurologist. I don't do repetitive work, but I did have whiplash about 10 years ago - not from a mva, but I fell backward in my work parking lot because the edge of the pavement broke under me and I whipped my head around as I was trying to catch myself and sprained my neck.

As for the hands up - I can hold them up both open and closed handed, and they don't hurt, but my fingers feel hot when I hold them over my head - same feeling I get where my nerve pain was from my lumbar region since I got my spinal epidural.

I will take a look at the vitamin d - they put me on 50,000 iU's 1x er week for 12 weeks and my levels went from 14 to 12 - their solution was to put me on the same thing for another 5 weeks which is a little disheartening. I'm not even sure how it's possible for me to have vit d deficiency since I send the majority of my days outside without sunblock, but I guess that's another story entirely.

mg neck prob - I will definitely be trying as many conservative approaches as possible before surgery - I did have the epidural for my low back and it was extremely painful for me, and I couldn't walk for a day and a half after I had it. My pain dr said that she could try a different medicine that was the type they normally used for necks the next time I need one, but I am terrified to have my neck done considering how painful my back was

[Leesa]

I'll try to help ~

C3-4 mild central canal stenosis (narrowing) with a mild rear disc bulge abuttment and flatting the front of the spinal cord. Spurring encroaches the neural foramina. The foramen are the holes that the nerves pass thru to get to the spinal cord.

C4-5 Moderate rear bone spurs and mild spurring and ventral abuttment and flattening of the cervical cord and moderate canal stenosis (narrowing). The foramina are mildly encroached. (narrowed)

C5-6 Mild spurring and mild rear disc bulge causing mild central canal stenosis.

Note: C3-4 and C4-5 Signs of Cervical Myelomalacia, which is spinal bleeding causing softening of the spinal cord; Hemorrhagic infarction of spinal cord can occur as a sequel to an acute injury. This should be further investigated. I would NOT let doctors take this LIGHTLY if I were you, but find someone who will investigate. Perhaps a teaching hospital.

Plus at C4-5 it indicates that the whole cord is flattened, not just a part of it, like at C3-4.

I definitely would want ANOTHER OPINION on this MRI. I'd go to a NEUROSURGEON if I were you. And then after that, get 2 MORE opinions! Don't rely on just one Neuro opinion. We're talking about some pretty serious issues here. So in total, get 3 opinions from Neurosurgeon, okay? And PLEASE, let us know what they say. I'd really like to know, and Im sure everyone else would too! God bless and please take care. Hugs, Lee

[silverfae]

Thank you Leesa.

Do you know, is the myelomalacia indicative of a recent trauma to the spinal cord, or could it be from the whiplash I suffered 10 years ago? And how bad is having the whole cord flattened?

[silverfae]

Well, I saw the neurologist today - he says I need surgery soon. He basically said that there is a lot of damage and if I were to fall wrong, I could become paralyzed due to the bruising on my spinal cord. He also said if I dont have surgery, I could just wake up some day partially or fully paralyzed

Going to try to get an appointment for a second opinion, but I don't know if I will be able to get in to see them in a timely fashion if I need surgery sooner rather than later

[Leesa]

The myelomalacia would NOT have come from the accident 10 years ago. It would have to have been something more recent. It can be caused by a disc protrusion being forced or pressed out by some sort of trauma/accident.

Your MRI showed SIGNS of it -- it doesn't mean that you actually HAVE it -- it means that further investigation should be made. Perhaps another MRI or even a Myelogram, however I don't if a myelogram would be dangerous for you. Your doctor would know.

You should still get more opinions as soon as your can. When calling for appointments, make sure the girl at the desk who makes appointments knows of the importance of getting in SOON -- that your condition warrants that you been seen ASAP.

I wish you the very best. Lets us know, ok? Hugs, Lee

[silverfae]

Thanks Lee, I will keep updating. Neurologist said there is definite bruising on the cord when he reviewed the images with me today and was very sure it is coming from the degeneration in my neck plus the congenital stenosis. I basically only had room for my spinal cord when I was born and now I have less My GP seems to be dragging her feet on making a referral for some reason, and is making me go meet with her again tomorrow (she just saw me last week and we talked about it - the only difference is that the neurologist now says go on the surgery) I am feeling so frustrated and broke - We have already paid over $1k in copays this year and a $1.5k deductible and I had to leave my job earlier this year due to all the problems I had with my lumbar disc herniation, and at $40 a visit to these specialists I am not sure how much longer I can keep it up

Wouldn't it be nice if all we had to do when we were ill was to worry about getting better? =)

[Leesa]

Boy, you're right there! I hate to THINK how much I've paid in copays this year. I shudder to think.

They HAVE to give you time to get other opinions. DON'T let them hurry you into the operating room. It isn't that much of an emergency. If you were having bowel or bladder problems -- and I mean SERIOUS problems -- then I'd say you might have to get right in to the OR. But it is NOt that much of an emergency, so you DO have time to get some opinions!!! Don't let them intimidate you! That's what they're good at -- intimidating patients!

You have your rights, and right now, you've got to get 2 other opinions! You can't place your LIFE on ONE guys opinion. What if he's wrong? Then you'd wish you'd seen the other 2, right?

So tell them you'll wait til you've seen the other 2. They have to give you that time. It's a smart move, and they have to respect you for that!

I know it's tough -- but I'm behind you as well as everyone else. Love, Lee