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Thread: MRI Scan - Wise (or anyone) can you help interp?

  1. #1

    MRI Scan - Wise (or anyone) can you help interp?

    I had an accidient in 2007 resulting in a contusion at T11/T12. I experience bad neuropathic pain from my hips to knees and also bad lower back pain. I haven't had any luck with medications to-date and currently use fentynal patches (100mg 2nd daily) to numb the pain. I'm currently looking into having a neurostimulator implant to help with the neuropathic pain and have recently had an MRI to see if it is going to be possible. I'm very cautious about the problems associated with an implant.

    Wise (or anyone else in the know) I'm hoping you could help me understand the MRI report which I have provided below.
    Does this help explain the increased neuropathic pain that I'm experiencing?
    Should I be looking at having the syrinx treated and what can be done?
    Is it likely that the annular bulging at L4/5 and L5/S1 is causing my lower back pain and if so is there anything that can be done to help with this?
    I would also like find out if I my injury has also caused damage to conus or not. Can this MRI can help answer this question? My sensory level is around my navel and my legs have strong spasms (i.e not flaccid).

    MRI Report (13 Aug 2011)
    INDICATION: T12/L1 paraplegia secondary to fracture in 2007. Increasing leg and back pain? syrinx.
    TECHNIQUE: Sagittal T1 & T2 and axial T2.
    FINDINGS: There is mild metalware artefact related to T11/12 fusion with transpedicular screws, posterior spinal rods and bone grafting. Previous T12 compression fracture is noted, there is a mild scoliosis convex to the right, thoracolumbar alignment is otherwise maintained.
    There is increased T2 signal and expansion of the cord beginning at T9/10 terminating at T12/L1 just proximal to the tip of the conus consistent with a syrinx, this has a maximal AP diameter of 10mm at both T11 and T12. The remainder of the visualised thoracic cord is of normal size and signal intensity. There is no focal constriction of the thecal sac.
    In the visualised thoracic spine, there is no focal disc protrusion although detail is reduced at T11 /12 due to metallic artefact. Central canal and neuroforamina are patent.
    In the lumbar spine, the thoracolumbar and upper three lumbar discs are normal. There is an early diffuse annular bulge at L4/5, and a mild diffuse annular bulge at L5/S 1. The central canal and neural foramina are patent.
    IMPRESSION: Distal thoracic syrinx from T9/10 to T12/L1 with a maximal AP diameter of 10mm. No focal disc protrusion.

    Thanks in advance for helping me with this, any help is much appreciated.

    Geoman
    "Wheelie Wanna Walk!"

  2. #2
    Geoman, I'm not a medical professional -- just someone who also has a syrinx (mine's in my brain stem). The following are my impressions.

    A syrinx with a 10mm (1 centimeter) diameter is a BIG syrinx. Even though there's no absolute correlation between syrinx size and the pain/damage it causes, I suspect that it's the syrinx that's causing most, if not all, of your increased neuro pain because of the pressure it's putting on your cord.

    Were this my MRI report, I'd first explore the possibility of collapsing the syrinx through de-tethering surgery and then investigate the possibility of the stimulator to help manage the pain.

    There's good news and bad news about treating the syrinx. If the surgery is successful, it will keep the syrinx from getting bigger and causing even more damage, pain, etc. The bad news is that collapsing the syrinx may not alleviate your increased pain. It will depend on how long and severely the cord has been compressed. Given the significant size of this syrinx, I'd say there's a very strong possibility that the damage it's caused to the spinal nerves is permanent.

    Hopefully Dr. Young will share his impressions and offer advice.

    Another resource worth checking out is the American Syringomyelia Alliance Project at http://www.asap.org which has a wealth of info on syringomyelia (SM), including forums like these for those living with SM and Chiari Malformations (CM).
    It is easier to find men who will volunteer to die, than to find those who are willing to endure pain with patience.

    ~Julius Caesar


  3. #3
    Hipcrip, Thanks for the info and advice.

    Geoman
    "Wheelie Wanna Walk!"

  4. #4
    I completely agree with THC. The mild annular bulges don't matter since your central spinal canal and neural foramina (where the spinal nerves come out) are not compromised. It is the syrinx that is the problem. It could easily contribute to your neuropathic pain although you can have miserable neuropathic pain even without a syrinx. But if it were me, I would be consulting with my friendly spine surgeon/neurosurgeon ( are they ever friendly?) and see what they think. Tethering from arachnoiditis or a syrinx definitely increases NP pain.

    In regards to your conus, your syrinx stops (is proximal) before ('north') the conus. Your conus stops right about L2........

  5. #5
    Thanks Arndog. I'm trying to organise seeing my neurologist (who happens to be friendly and a stunner, but very busy and difficult to get in to see).

    Hipcrip/Arndog, from your experience do you think that it is the syrinx that would be causing the increased spasms that I have experienced over the last 12 months?
    "Wheelie Wanna Walk!"

  6. #6
    Geo - I really don't think it is possible to tell over the internet. See what your neurologist thinks.....

  7. #7
    I have 1 too, I've had it popped and my cord untethered. I'm a c-6 and it's @ c3. Syrinx was 3.5cm attached to the cord filling up with csf. I still have symptoms and I'm just trying to learn more about these things and coming here has helped.

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