Hi guys,

I haven't been signed in for a while. I have DDD, cervical stenosis and the doctor thinks I am now in pre myelopathy and recommending surgery immediately. A anterior Two level discectomy and corpectomy of C6. Fusion with my bone marrow from hip and cadaver bone. I just had an MRI and they are comparing to my March 2013 MRI. the doctor says I am testing positive myelopathy at my last appointment and wants me to have emergency surgery. My pain is still manageable and I can still manage with balance. I have bilateral radiculopathy. My hands are my worst problem but they have been worse I can still manage.

My main question is, do these MRI results show myelopathy and am I at risk of permanent paralysis or can I still wait a while before surgery.

If anyone can explain these results or has any input It would be very much appreciated. I have to meet with the neurosurgeon tomorrow and need to make a decision when we review this MRI. I just copy and pasted the MRI

Thank you

Rhondaroo

HISTORY: Cervical spine stenosis with myelopathy and progressive imbalance.

COMPARISON: MRI of the cervical spine dated March 1,2013.

TECHNIQUE:MR of the cervical spine was performed with axial and sagittal Tl and T2-
weighted images, without IV contrast infusion.

FINDINGS: There is stable straightening of the normal cervical lordosis with slight kyphotic
angulation in the mid cervical region. Multilevel moderate to severe degenerative disc changes
are present with stable moderate to severe canal stenosis through the mid cervical spinal canal.
Mixed Modic type one and type II disco genic degenerative endplate changes with extensive bone
marrow edema in the C6 vertebral body are unchanged compared to the prior MRI. No
compression deformity is seen. The slight cervical thoracic dextroconvex angulation with the
apex at C7 is also unchanged compared to the prior MRI coronal images.

The cervical cord remains normal in size and signal intensity on the sagittal and axial T2-
weighted images. Indistinct signal on the sagittal T2-weighted and STIR images, not seen on the
axial T2-weighted images, represents artifact. The craniocervical junction remains unremarkable.

At C l-C2 the atlanto-axial articulation, predental space and atlanto-occipital alignment are
within normal limits (seen in sagittal plane only).

At C2-C3 the midline and right osteophytic ridge is unchanged with mild encroachment on the
anterior thecal sac. Mild canal stenosis is stable. No facet arthropathy is seen. Neural foramina
remain widely patent bilaterally.

At C3-C4 there is stable right greater than left uncovertebral hypertrophic change which
produces mild slightly asymmetric canal stenosis. No cord contour change or abnormal signal.
Stable mild facet arthropathy bilaterally. Severe neural foramen narrowing is again seen
bilaterally.

At C4-C5 there is stable right greater than left uncovertebral hypertrophic change with small
focal osteophytic protrusion on the right. Moderate canal stenosis with slight cord contour
change is unchanged. Cord signal remains normal. Mild bilateral facet arthropathy is stable.
Moderate neural foramen narrowing is again seen bilaterally.

At C5-C6 there is stable large irregular osteophytic ridge with prominent left paramedian focal
protrusion. This produces severe central canal stenosis with cord contour change. Cord signal
remains normal. Moderate bilateral facet arthropathy is unchanged. Severe left and moderate
right neural foramen narrowing are again noted.
At C6-C7 the broad disc osteophyte protrusion again produces severe central canal stenosis with
cord contour change. Cord signal remains normal. Mild facet arthropathy is again seen
bilaterally. Severe left and moderate right neural foramen narrowing are unchanged.
At C7 - TIthe disc height and signal are within normal limits with no evidence for focal
protrusion or uncovertebral hypertrophic change. Spinal canal is widely patent. Neural foramina
are widely patent bilaterally. No facet arthropathy is noted.
The visualized soft tissues of the neck are within normal limits with no evidence for mass,
infiltrative disease or thyroid abnormality, although partially obscured by the saturation band
anteriorly .. Unchanged.
IMPRESSION:
There is stable straightening of the normal cervical lordosis with slight kyphotic angulation in the
mid cervical region. Multilevel moderate to severe degenerative disc changes are present with
stable moderate to severe canal stenosis through the mid cervical spinal canal. Mixed Modic type
one and type II discogenic degenerative endplate changes with extensive bone marrow edema in
the C6 vertebral body are unchanged compared to the prior MRI. No compression deformity is
seen.
The cervical cord remains normal in size and signal intensity.
C2-C3, stable midline and right osteophytic ridge. Mild canal stenosis. Widely patent neural
foramina.
C3-C4, stable right greater than left uncovertebral hypertrophic change. Mild asymmetric canal
stenosis. Severe neural foramen narrowing bilaterally.
C4-C5, stable right greater than left uncovertebral hypertrophic change with focal osteophytic
protrusion on the right. Moderate canal stenosis. Moderate neural foramen narrowing bilaterally.
C5-C6, stable large irregular osteophytic ridge with prominent left paramedian focal protrusion.
Severe canal stenosis with cord contour change. Normal cord signal. Severe left and moderate
right neural foramen narrowing.
C6-C7, stable broad disc osteophyte protrusion with severe canal stenosis and cord contour
change. Normal cord signal. Severe left and moderate right neural foramen narrowing.
C7-T1, within normal limits

I'm certainly no expert in reading MRI's but in regard to your question about myelomalacia, this is the portion of your MRI that stuck out to me:

The cervical cord remains normal in size and signal intensity on the sagittal and axial T2-
weighted images. Indistinct signal on the sagittal T2-weighted and STIR images, not seen on the
axial T2-weighted images, represents artifact. The craniocervical junction remains unremarkable.

Myelomalacia shows up on the T2 images of the MRI. It looks like that when they used STIR which is a more precise way of looking at things, there was a signal that showed up but it is noted as being indistinct. That may be why your doctor has stated he feels you have "pre myelomalacia".

Severe stenosis + cord contour change without signal change = your docs likely supposition for pre myelomalacia. The term "artifact" means nothing is really there. If one of your docs says clinically you have myelopathy, you need to listen to him! Your problems could quickly become irreversible.