Myelopathy but no cord compression....

Myelopathy but no cord compression....

Q:

Age: 40 Sex: F Concern: Spinal cord injury

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

A:

Something is going on. It is not normal to have hypereflexia and incontinence. I don't think you should wait to sort out the diagnosis. See the ns then go see a neurologist or get a second opinion from another ns. Pay out of pocket if you have to. Cross the border and see an American doctor. Is the hypereflexia in both the upper and lower extremities or only in the lower. Is the babinskys positive. At the minimum I think you need to hVe MRI of the thoracic and lumbar. Emg/ncs of the arms and legs would be helpful to rule out ALS and radiculopathy.

-- Sherman Nam Tran, M. D.

to ask Dr. Tran.