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Thread: Herniated Spinal Cord, Dura Reconstruct, Post-op MRI

  1. #1

    Herniated Spinal Cord, Dura Reconstruct, Post-op MRI

    New Hello!

    I was diagnosed with idiopathic SC herniation through hole in anterior dura at t6-7 with myelopathy 11/2013 following MRI. Surgical dural reconstruct through partial t5 and full t6-7 laminectomy was performed using bovine sling 12/3/2013. I had symptoms for more than 5 years prior to diagnosis, but rapid progression the few months before. I am ASIA D. Short distance ambulatory, long distance wheeler.

    I am concerned about my post-op MRI, although my surgeon reports all changes are consistent with the myelopathy. Any thoughts would be appreciated.

    Postoperative 4 month MRI reveals --
    thin epidural collection t5-t8--possible seroma,increased encephalomalacia t6-7, persistent t6-7 disc bulge, spinal cord is no longer ventrally drawn and circumferential patch is present t6-7, central canal stenosis t6-7 due to disc bulge and dorsal seroma--however no cord compression although no CSF is seen at t6-7 level, mild unchanged compression deformity on superior end plate t7--possibly schmorl's node, increased T2 signal within laminectomy site and soft tissue overlying t5-7 representing normal post surgical changes. No abnormal signal present after contrast. Discs appear normal except disc desiccation and small posterior t6-7 bulge.

    Understanding this diagnosis is rare, I'm hoping to connect with someone that has experience with this problem.
    Last edited by DonnaT-PTwithSCI; 04-23-2014 at 05:44 PM.

  2. #2
    As you can see you still have issues. Seroma- you still have the fluid after all these months which needs to resolve and it is causing the tissue around it to not be normal. You still have the disc bulges . Did they not want to remove the disc bulge? What did your doctor say?

  3. #3
    Doc says all findings are conclusive with myelopathy from the herniation. Prior to surgery he did not have concern with the disc bulge. I would think that it was apparent during surgery...perhaps it has progressed? I'm unsure now as he did not address it. Do seromas naturally happen post surgery and need to absorb/dissolve or would it be a complicating factor? I am unclear what is normal post surgically-- I'm also concerned that there is no CSF flow at injury level. With the sling in place, should CSF flow return to normal? Lack of CSF flow seems like it would create additional problems potentially-- adhesions, etc. Thoughts?

  4. #4
    Yes the seromas can slowly resolve.
    Myelopathy is a generic term which means there is damage. If he thinks from herniation he didn't fix the disk or remove or maybe he thinks the damage is done.The canals stenosis or the no or minimum CSF circulation is from the disk.. it should be getting circulation from the other part not stenotic so should be getting some flow. Very complex and you really need to get more information from the neurosurgeon. He is looking directly at the x-rays and must have some reason.
    Again if disk doesn't protrude more and involve the cord or more nerves, you won't get worse... of course you may not get better.
    There is thought that some disks slowly go back in and resolve somewhat over time and surgery isn't needed.

  5. #5
    Thank you for the replies.

    so I'm thinking encephalomalacia, myelomalacia and myelopathy are synonymous...?

  6. #6
    To varying degrees encephalomalcia and myelomalacia are very similar-refers to damage seen on MRI.
    Myelopathy is a condition or diagnosis that encompasses your symptoms. And can go along with your"idiopathic" etiology.

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