All You Ever Wanted to Know About My C-Spine But Were Afraid to Ask

MRI - L-SPINE WO CONTRAST - Mar 11, 2008. There is focus of increased T2 signal in the spinal cord at the C5-6 level. At the C2-3 level, minimal bulge. Thecal sack is 1.1 cm in the AP dimension. The neural foramina and central canal are intact. At the C 3-4 level, there is a right neural foraminal narrowing. Thecal sac is 1 cm in the AP dimension. The left neural foramen and central canal are intact. At the C4-5 level, mild bilateral uncovertebral and right greater than left facet degeneration. Mild bulge. Thecal sac is 1 cm in the AP dimension. The central canal is patent, but bilateral neural foraminal narrowing is seen. At the C5-6 level, large broad posterior disk protrusion asymmetric to the right measuring 3 mm in the AP dimension and 14 mm broad. The thecal sac is narrowed down to 6-7 mm in the AP dimension. There is mild uncovertebral degeneration bilaterally with neural foraminal narrowing. There are foci of increased T2 signal in the spinal cord, possibly representing myelomalacia. At the C 6-7 level, small broad posterior disc protrusion measuring 2 mm in the AP dimension and 14 mm broad. The thecal sac measures 9 mm in AP dimension. The neural foramina are mildly to moderately narrowed and central canal is patent.
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Those are the salient results from my MRI, other than the fact that my thoracic and lumbar spine is fine. Here are some glossary terms to help make sense of the above.

Thecal sac -- thin walled tube that circulates cerebral spinal fluid (CSF).

Neural foramen - an opening between the vertebrae through which nerves leave the spine and extend to other areas of the body.

Central canal - the central canal through which the spinal cord and thecal sac run.

Patent - open, unobstructed.

Uncovertebral - hook-shaped vertebrae (I think).

and, perhaps most importantly,

Myelomalacia - permanent softening or necrosis of the spinal cord.
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I was able to get my neurologist on the phone, and Dr. Cutie got back in my good graces by having the most frank and useful talk with me that we've had since I left the hospital. In a nutshell, it goes something like this:

• there is still a signal change (which means a change in the signal produced by the MRI, indicating a spinal cord injury -- I guess it's easier to tell someone they have a "signal change" than that they have a spinal cord injury) at the same level, C5-6, where I had my surgery. The doctor who reviewed the MRI, at least, thinks it may be permanent (myelomalacia). It is also pretty serious -- note that the thecal sac is 1 cm or more in diameter at other points in my spine, but there it is 3 millimeters. In addition, other parts of my cervical spine, including at C6-7 and elsewhere, there are also some significant problems. In other words, my cervical spine is FUBAR. For this reason, Dr. Maragakis wants Dr. Witham, the neurosurgeon, to review the results and call me as soon as possible. Without coming out and saying so, what he said was that there is a possibility I will need more surgery. Apparently only Dr. Witham can say for sure.
• For once, this scan made Dr. M admit that all of my existing symptoms are probably related to my cervical spine problems (and not some mystery disorder), although he says he still can't explain my double vision (hello, gestation!!) and that he hasn't given up on looking for an alternate cause (I think it was myasthenia gravis in the library with a toaster!). This seems like bad news. If it's not the case that I can't walk because I got pregnant, then the fact that I'm no longer pregnant no longer means that I'll automatically return to walking.
• The thoracic and lumbar spine is fine, which is good news. This means that the uneven recovery of my right and left legs (right staying weak, left getting stronger) is not due to a previously undiscovered problem in my low disks. It is also very unusual for this level of disk degeneration to be so localized -- usually if someone's disks are as bad as mine, they are that way all up and down the spine, not just in the neck. I have a theory about this, which is that all those years of stress and muscle spasms in my neck hastened the falling-apart of that part of my spine, whereas otherwise it might not have flared up until I got a bit older, like Dad. (I almost certainly have a genetic form of degenerative disk disease, since Dad has it and I had such an early onset.)
• There are a great many unknowns here. When I came to Hopkins, as Dr. M put it, my spinal cord was "very strongly squished." Will my spinal cord recover from the existing injury? What further injuries or surgeries await? Apparently there's really no way to predict. He said that arguably, a head or neck trauma could paralyze me, but as I have a desk job he isn't all that worried. Perhaps the man hasn't noticed that I keep falling over. Anyway, as far as preventative measures go, Dr. M says Dr. W will know more about that than he.
• Here's an important point: Dr. Maragakis says there is not always a correlation between the myelopathy (again, another word for spinal cord injury) and functionality. He told me a story about an 80-year-old patient of his who on MRI shows extremely severe myelomalacia in her lumbar spine, but has absolutely no symptoms whatsoever. They aren't even bothering to operate on it, partly because she's so old, but partly because it's not causing her any problems. The relevance to me is this: even if my spinal cord injury never heals, I may still be able to walk better than I do now, eventually. Dr. M said that sometimes spinal cord injuries do heal, and if they don't, sometimes the body can learn to adjust to the new situation, so that things like balance problems, hyperreflexia, and gait spasticity like mine are eventually lessened.
• He said PT and muscle strengthening are going to be very important. This also seems like bad news. At least part of the outcome is up to me. And who trusts me? Certainly not me.

Truth is, it seems like a vicious circle: I need to work hard to rehab, or I may never walk any better, ever again. Yet I haven't been able to rehab well because I have such severe back pain. The back pain is caused by my inability to rehab well. You see where this is going -- nowhere. Ironically, by the way, my back pain is not caused by the problems in my spine -- except maybe to the extent that walking funny means my back muscles are compensating for my weak legs. And no one besides the physical therapists is really concentrating on reducing my back pain.

And ahem, when did it get so hard to get a hold of pain killers!?! I mean, Rush Limbaugh was addicted to them, and I have at least one friend who takes them for fun. How come I can't get any?? How come I have to limp-whimper around the house like a decrepit old lady, prying myself up out of chairs with my flabby-sad arms, calling my husband (or the dog) to pick things up that I've dropped, unable to lift my rapidly growing baby? Maybe if I had painkillers I could at least work on some loosening of those muscles. As it is, D and I are back to the old bunker mentality, trying to figure out how to fit both our jobs and all of our family responsibilities into one life where one "partner" is really only a burden, not a help.

Do you know what I want? I want our home to be a place full of laughter and rest. I want D to come home for the evening, and I want to greet him, looking forward to the fun of being home, the relaxation to be found here. Instead I'm afraid he thinks of coming home as his second job, where only more emotional distress and physical demands await him. It makes me angry, fills me with guilt, and breaks my heart. Thank God Abby is here. She is keeping us sane, giving us moments of joy in every day. No pressure, Baby.