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Forum Name: Neurology Topics

Question: Myelopathy but no cord compression..differential diagnoses?


 shadyrn - Thu Nov 19, 2009 6:49 pm

Had issues 4.5 yrs ago....saw NS, had myelogram, no need for surgery.....jump ahead to present, neck spasms started and I put this together with shakiness going down stairs, incontinence issues, and hyperreflexia(my reflexes are so brisk it's like clonus) and wanted to see NS again...of course had to go through proper channels and see PCP first...he ordered steroids and a STAT Mri....I am a nurse so I'm at either an advantage or disadvantage in thinking too much about this! MRI findings:

There is mild stranding of the cervical lordosis which could be secondary to the patient positioning or muscle spasm.

The cervical spinal cord is normal in signal and caliber.

The is no focal disc herniation, central stenosis or neural foraminal narrowing in C2-3, C3-4, or C4-5.

At C5-6 there is mild disc space narrrowing. There is diffuse disc osteophyte complex which abuts the spinal cord without evidence for cord compression. There is mild central narrowing at this level. There is mild-to-moderate left and mild right neural foraminal narrowing at this level. The disc osteophyte complex appears to have slightly increased in size since 2005.

The C6-7 and C7-T1 levels are within normal limits.

IMPRESSION:
Degenerative disc disease at C5-6. The disc osteophyte complex at C5-6 may have slightly increased in size and abuts the spinal cord. However, there is no evidence for cord compression at this level. There is bilateral neural foraminal narrowing at C5-6 as described.

So it sounds not too bad from the MRI....my understanding though is that there may need to be intervention with signs of myelopathy?!?!? I remember 4.5 yrs ago the NS commenting that my symptoms present as indicating cord compression with the myelopathy, yet the findings don't indicate this degree.....so I'm waiting for my appointment 12/10/09- I feel like I will be wasting my time along with the NS if there is really nothing going on with the spinal cord, yet I show the signs of myelopathy?!?!.......would appreciate any feedback or similar stories here as I patiently wait for my appt in Dec.

Thanks for reading


-- shadyrn
 John Kenyon, CNA - Mon Jan 11, 2010 10:47 pm

User avatar Hi there -- While there could be some association between the DDD found on MRI and the symptoms and signs of myelopathy, there doesn't seem to be any visible mechanism, which is probably why the follow up. There is a possibility of comorbidity
with symptomless or only mildy symptomatic DDD, plus some entirely unrelated central disease process (such as MS) that needs to be explored and ruled out or in. There's no point in overthinking it prior to the appointment (which has now, presumably, taken place), but I realize how hard that is to avoid, especially when one's in the business.

I would think an additional MRI (of the brain) would be in order to rule out MS, and perhaps nerve conduction testing in the extremities. If this is all negative and there is no evidence of any other similar neuro disorder. If none is present, there has to be some slippage in the area of the spinal lesion that maybe is causing nerve outlet compression part-time. It happens, and it can make the diagnosis more difficult. Eventually, though, things will settle into position more or less permanently, and can then be identified.

That's about all I can tell you at this point, but you probably know more now. I hope this is helpful and by all means please do follow up with us here. Good luck to you.
 shadyrn - Tue Jan 12, 2010 10:47 am

just got back from nuerosurgeons today! Cervical MRI was OK to him, but with symptoms he ordered thoracic- that also came bac OK....neurologist did upper extremity EMGs which showed bilateral ulnar neuropathies and also C8 radiculopathy...blood workup also came back negative....so, I guess I just have extremely brisk reflexes and 2 beats of clonus and weakness going down stairs for no neurological reasons anyway...NS said go see neurologist but already did that, so at least I know I don't need surgery, but still wonder why these symptoms continue.....

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