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**Wise Young** · 24 Jun 2010, 9:12 PM

Originally posted by Ruby-rose View Post

My Neurologist in Melbourne, Aust. has told me I has Myelomalacia of my cervical cord, from whiplash in a mva. I have no muscle tone in my anus, vagina, calves and have trouble walkign as my gait is not normal. I stumble everywhere in walking and when getting up from a chair or out of bed. I have constant Lower Back Pain and I am now on Norspan 20mg patches weekly.

What does this report actually mean in terms that I can understand please?

Diagnostic Report:

Diagnosis:

MRI CERVICAL SPINE

CLINICAL NOTES:
Whiplash injury. Chronic
pain. Previous cervical MRI showed dorsal column
lesion.

FINDINGS:
The study of 23/1/2010 is available for review at the time of this report.

Once again one notes the presence of abnormal high signal intensity in the dorsal cord commencing at the level of the C2-C3 disc and continuing in a patchy distribution as far inferiorly as the C6 vertebral level. This focus is located too far posteriorly to be a dilated central canal despite its rather tubular appearance and indeed superiorly the focus divides into two. There is no abnormal enhancement. Disc bulging is present at several cervical levels most prominently at C6-C7. No neural compromise identified at any of the imaged levels. The craniocervical junction is normal.

COMMENT:
The pattern of rather tubular and dorsally oriented abnormal high signal intensity in the cervical cord is confirmed. This does not have the appearance of a dilated but otherwise normal central canal in so far as the abnormality is too far posteriorly. Clinical correlation is advised in this respect because if this focus is a manifestation of myelomalacia it should be clinically eloquent. There is no abnormal
enhancement of the cord.

Electronically Signed By:

Dr Julian Adler
MBBS
(Hons), FRANZCR

Thank you in advance for any comments to help me.

Ruby Rose

Dear Ruby Rose,

Norspan is buprenorphine, a long acting form of morphine. It is used to treat severe pain that is refractory to other medication.

Regarding your MRI findings, first let me define myelomalacia. The term literally means "bad white matter" that results from spinal cord injury. There is often progressive damage after an initial spinal cord injury and subsequent development of myelomalacia. Magnetic resonance images of the spinal cord often show abnormal increases in signal intensity, which is indicative of increased water content in the spinal cord.

Your MRI report indicates that you do have increased magnetic resonance signal in your cervical spinal cord. The statement that there is no enhancement probably refers to the absence of dye enhancement of the spinal cord, suggesting that they injected a dye during the test and found that the dye did not increase the signal in the spinal cord. This indicates that you do not have increased vasculature of the spinal cord and this is normal. While you have disc bulges at C6-7, there was no evidence of spinal cord compression.

As you know, all this is likely to have resulted from your spinal cord injury and the MRI is showing the changes in your spinal cord, consistent with your neurogical loss and gait disturbance. I am, however, puzzled why you are not describing more symptoms in your arms which should have been affected by a cervical spinal cord whiplash. The fact that you have lower back pain as well suggests that some attention to be paid to the lower back. Did you get a lumbosacral MRI as well?

Wise.

**Ruby-rose** · 25 Jun 2010, 10:39 PM

Thank you for your reply and explanations. Yes I do have problems with my arms. Pain in shoulders and bi-cep muscles and in my wrists. I find it hard to type for long or hold a book etc. Drop things constantly from my hands, I have to look at the object in my hand to make sure I have it held properly.

The Neurologist said; you are so lucky you are not paralized, it was very close to being that.

So your thoughts on my future could hol and what one could expect to happen?

Also how can they tell on a MRI if this is stable or progressive?

Thanks again,

Ruby-rose

**Ruby-rose** · 25 Jun 2010, 10:49 PM

Hi Wise,

I had a full Spine MRI including my brain. The MRI indicated my brain is clear and my L3/4 tear. The pain is directly in the spine bone from my L3 down to just above my coxus. I have had that pain for four years, localized in the bone. Had bone scans etc and all clear of having having any cancer etc. But pain is there 24/7 in varying degrees, hence the norspan I have been on since Dec 09. I have seen 4 Neurologists with no one be able to confirm why my lower back has so much pain.

Thanks,

Ruby-rose

**Wise Young** · 25 Jun 2010, 11:10 PM

Originally posted by Ruby-rose View Post

Thank you for your reply and explanations. Yes I do have problems with my arms. Pain in shoulders and bi-cep muscles and in my wrists. I find it hard to type for long or hold a book etc. Drop things constantly from my hands, I have to look at the object in my hand to make sure I have it held properly.

The Neurologist said; you are so lucky you are not paralized, it was very close to being that.

So your thoughts on my future could hol and what one could expect to happen?

Also how can they tell on a MRI if this is stable or progressive?

Thanks again,

Ruby-rose

Originally posted by Ruby-rose

Hi Wise,

I had a full Spine MRI including my brain. The MRI indicated my brain is clear and my L3/4 tear. The pain is directly in the spine bone from my L3 down to just above my coxus. I have had that pain for four years, localized in the bone. Had bone scans etc and all clear of having having any cancer etc. But pain is there 24/7 in varying degrees, hence the norspan I have been on since Dec 09. I have seen 4 Neurologists with no one be able to confirm why my lower back has so much pain.

Thanks,

Ruby-rose
Today 10:39 PM

Ruby-rose,

I see. Yes, the facts that you do have symptoms in your arms and that you have long-standing lumbosacral pain confirm that your myelomalacia is likely to be responsible for most of your neurological loss. Indeed, you are lucky. You have had spinal cord injury. It is hard to predict from MRI what will happen. Some people get worse and others get better.

In my opinion, not using your arms and legs will aggravate loss of function. I encourage you to keep walking, even though your gait may be abnormal and it may be painful. You may want to take up swimming as a means of exercise because it is the least stressful to your bones and back, and it will exercise both your arms and legs.

There is no rationale for surgery.

Wise.

**Ruby-rose** · 26 Jun 2010, 9:26 AM

Dear Wise,

Thank you, I am so very grateful that you have answered my previous questions and you have made it very easy now for me to understand.

I did not understand my condition when told and therefore did not have questions to ask at the time. If may ask just a few further questions please, I would be very grateful for your time and expertize again.

1: Can the myelomalacia progress to the point that it can cause me to become
paralyzed. In being so close to have being from the accident.

2: With the damage I have already have sustained, if I were to have another
whiplash injury would this be likely to kick start the myelomalacia off again?

3: How serious is my condition as it is presenting now?

4: Do I have what you call an in-complete spinal cord injury?

You are a kind person giving up your free time in helping people all over the world in answering their questions and concerns. I myself am grateful for your time that you have given me.

Thank You again
Ruby-Rose

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Myelomalacia and MRI Results

Myelomalacia and MRI Results

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