Hi Everyone, I'm a newbie and would like to know anyone's opinion on my full spinal MRI, specifically MYELOMALACIA. I am familiar with most of the findings, I just wanted other opinions. Considering changing my neurosurgeon, I feel he isn't telling me everything. Just brushes things off to arthritis, which I do know is present, but there are other things going on from what I'm feeling and the findings that he's not even willing to take the time to answer my questions about. What I'm feeling isn't in my head, I live with CONSTANT, DAILY PAIN, and this is just my spine, not including the other areas of my body. Thanks in advance .


Technique:
Sagittal T1, sagittal fast spin-echo T2, axial T2 weighted fast spin
echo and axial T2 weighted gradient images of the cervical spine were
obtained. Sagittal and axial T1 weighted images were obtained after
the intravenous injection of 20 ml. of Magnevist from a single dose 20
mL vial.

Axial and sagittal T1 and T2-weighted images of the thoracic and
lumbar spine were obtained without the administration of intravenous
contrast.

Findings:
Cervical spine:
There is anterior fusion hardware of C4-C5. There is no evidence of
fracture or subluxation. There is straightening of cervical lordosis.
The craniocervical junction is unremarkable. Visualized intracranial
structures are unremarkable.

There is redemonstration of linear increased T2 signal within the left
lateral aspect of the spinal cord at C4-C5 with associated mild cord
atrophy. There is no expansile spinal cord lesion. There is no
pathologic enhancement.

There are multilevel degenerative changes of the cervical spine.

At C2-C3, there is a left paracentral disc protrusion with mild
flattening of the left ventral aspect of the spinal cord and
flattening of the ventral left C3 nerve root.

At C3-C4, there is a broad-based spur disc complex abutting the spinal
cord and resulting in mild left neuroforaminal stenosis. The disc
component at this level is smaller when compared with prior MRI,
abutting the cord without spinal cord compression.

At C4-C5, there is a broad-based disc spur complex with bilateral
uncovertebral joint fusion resulting in mild to moderate bilateral
neural foraminal stenosis.

At C5-C6, there is a broad-based disc spur complex with moderate
bilateral neuroforaminal stenosis. There is no significant spinal
stenosis.

At C6-C7, there is a broad-based disc spur complex with mild narrowing
of the bilateral neuroforamina. There is no significant spinal
stenosis.


Thoracic spine:
There is no evidence of fracture or subluxation. Vertebral body
heights and alignment are maintained. There is no pathologic marrow
signal. Thoracic spinal cord has normal caliber and signal intensity.
There is right facet hypertrophy at T4-T5 with mild right
neuroforaminal stenosis. At T5-T6, there is bilateral facet
arthropathy with mild right neuroforaminal stenosis.

Lumbar spine:
The conus terminates at T12-L1. Caudal spinal cord has normal caliber
and signal intensity.

There is no evidence of fracture. Vertebral body heights are
maintained. There is no pathologic marrow signal. There is grade 1
anterolisthesis of L3 on L4 and grade 1 retrolisthesis of L4 on L5.
Alignment is otherwise anatomic. There are multiple levels of disc
desiccation and degenerative change.

At L1-L2, there is a mild broad-based disc bulge with mild compression
of the thecal sac.

At L2-L3, there is a mild disc bulge with bilateral facet arthropathy
resulting in mild impression upon the thecal sac.

At L3-L4, there is mild broad-based disc bulge with small superior
disc migration eccentric to the left. There is bilateral facet
arthropathy. There is mild ventral and posterolateral thecal sac
compression.

At L4-L5, there is a broad-based disc bulge with inferiorly migrated
disc protrusion eccentric to the right. There is bilateral facet
arthropathy with mild sac compression.

At L5-S1, there is a broad-based disc bulge with inferior migration
and bilateral facet arthropathy without significant central or
neuroforaminal stenosis.

Impression:
1. Anterior cervical fusion hardware with disc components at C3-C4
abutting the cord and no longer compressing the cord.
2. Unchanged linearly increased signal in the left lateral aspect of
the spinal cord at the C4-C5 level with associated mild cord atrophy
consistent with myelomalacia.
3. Multilevel degenerative changes of the cervical spine as described
above.
4. Mild multilevel facet arthropathy and neuroforaminal narrowing of
the thoracic spine.
5. Multilevel degenerative changes of the lumbar spine as described
above.

Hi Mzdaisy,

What are your specific questions or concerns ?

Is the news of a dx of myelomalacia new to you ? Is that the reason you are considering changing neurosurgeons ? Or is it because you do not feel that your pain is being well managed ?

The presumed myelomalacia at C4-C5 could have been caused by your previous surgery/fusion there. It says those findings are unchanged from your last MRI.

Unless another surgery is indicated, which you didn't mention your neurosurgeon is planning, ongoing pain and symptom management with spinal issues would normally be handled by a neurologist, pain clinic, or PCP.

Many of us have ongoing issues with severe pain because we don't have a condition that can be fixed by surgery. We have chronic conditions that will never go away or be cured, we will always deal with pain. What we can hope for is a medical team that helps us find tools (could be nerve blocks, anti-inflammatories, narcotics, other meds, exercise, PT, massage, ice, heat, TENS, meditation, visualization, cognitive behavioral therapy to name just a few options) that will help us decrease our pain levels to a more manageable level.

Do you have a PCP, pain clinic, or neuro who is working with you to help you manage your pain ?