Dr. Young -MRI question

LFC · 03-06-2004, 10:13 AM

Dr. Young,

My son had an MRI done 8 months post C3 injury and the neurosurgeon who read it said that he has a small hole in his cord, which is filled with fluid. He had a contusion, and I am assuming that the injured area walled itself off. (?) I was very surprised to hear that there was a hole, because although it has been slow, he has recovered significantly. I would think that a hole, even a small one, would not allow for that kind of recovery. I asked the doctor if he expected the hole to be there, and he said he would have been surprised if it wasn't there. He said there is nothing that should be done about it, that it is not a syrinx. He is a very nice man, but always in a hurry to move on to the next patient. I was flustered and didn't ask him any more questions. I guess my question is; with a hole in the cord, how would the signals still manage to get past that site? It seems like it would be a major block. My son has voluntary movement and control in all muscles (except the one that works his right little finger) although one leg is weaker and one arm/hand is extremely weak. I was told early on by a great young physiatrist that the spinal cord is a lot more plastic than doctors used to think. Is this an example of that plasticity?

Thank you for your time, and all that you do.

LFC

Wise Young · 03-06-2004, 10:36 AM

LFC,

There are two kinds of "holes" in the spinal cord after injury. The first is called a post-traumatic cyst, an empty area in the injury site that is left when the dead cells are cleared out. This occurs in perhaps as many as a third of people with spinal cord injury. I agree with his doctor in that there is nothing that can or should be done about that right now. There are clinical trials that are going on with cell transplants and other approaches to treating injury site and these are likely to "fill in" or "bridge" the injury site.

The second kind of "hole" results from an expansion of the central canal, normally a small canal that runs in the central part of the spinal cord. These are called syringomyelic cysts or syrinx for short. These occur when there are subdural/arachnoid scars that develop on the outer surface of the spinal cord, obstructing cerebrospinal (CSF) fluid flow. The current theory is that some of the CSF flow may be diverted into the central canal and enlarge that canal, just as increased water flow would enlarge a river. The treatment for syringomyelia is to clear the adhesions and provide a path for CSF flow and the syringomyelic cyst goes away 70-80% of the time. It does not sound as if your son has a syringomyelic cyst. However, his cyst should be followed up regularly, probably with annual MRI scans.

I am very glad to hear that your son has good sensation and voluntary control of all his muscles (except his pinky). Yes, indeed, his physiatrist is correct in pointing out the spinal cord is very "plastic". Much evidence suggests that as little as 10% of the spinal cord can support substantial functional recovery. Your son is very lucky.

Wise.

alan · 03-06-2004, 05:06 PM

I have a large hole between low C-4 and C-6, but it's apparently been stable all these years, according to MRIs.

Alan

"Was it over when the Germans bombed Pearl Harbor?"

03-06-2004, 10:13 AM	#1
LFC Senior Member Join Date: Jan 2004 Posts: 100	Dr. Young -MRI question Dr. Young, My son had an MRI done 8 months post C3 injury and the neurosurgeon who read it said that he has a small hole in his cord, which is filled with fluid. He had a contusion, and I am assuming that the injured area walled itself off. (?) I was very surprised to hear that there was a hole, because although it has been slow, he has recovered significantly. I would think that a hole, even a small one, would not allow for that kind of recovery. I asked the doctor if he expected the hole to be there, and he said he would have been surprised if it wasn't there. He said there is nothing that should be done about it, that it is not a syrinx. He is a very nice man, but always in a hurry to move on to the next patient. I was flustered and didn't ask him any more questions. I guess my question is; with a hole in the cord, how would the signals still manage to get past that site? It seems like it would be a major block. My son has voluntary movement and control in all muscles (except the one that works his right little finger) although one leg is weaker and one arm/hand is extremely weak. I was told early on by a great young physiatrist that the spinal cord is a lot more plastic than doctors used to think. Is this an example of that plasticity? Thank you for your time, and all that you do. LFC

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03-06-2004, 10:36 AM	#2
Wise Young Administrator Join Date: Jul 2001 Location: New Brunswick, NJ, USA Posts: 37,975	LFC, There are two kinds of "holes" in the spinal cord after injury. The first is called a post-traumatic cyst, an empty area in the injury site that is left when the dead cells are cleared out. This occurs in perhaps as many as a third of people with spinal cord injury. I agree with his doctor in that there is nothing that can or should be done about that right now. There are clinical trials that are going on with cell transplants and other approaches to treating injury site and these are likely to "fill in" or "bridge" the injury site. The second kind of "hole" results from an expansion of the central canal, normally a small canal that runs in the central part of the spinal cord. These are called syringomyelic cysts or syrinx for short. These occur when there are subdural/arachnoid scars that develop on the outer surface of the spinal cord, obstructing cerebrospinal (CSF) fluid flow. The current theory is that some of the CSF flow may be diverted into the central canal and enlarge that canal, just as increased water flow would enlarge a river. The treatment for syringomyelia is to clear the adhesions and provide a path for CSF flow and the syringomyelic cyst goes away 70-80% of the time. It does not sound as if your son has a syringomyelic cyst. However, his cyst should be followed up regularly, probably with annual MRI scans. I am very glad to hear that your son has good sensation and voluntary control of all his muscles (except his pinky). Yes, indeed, his physiatrist is correct in pointing out the spinal cord is very "plastic". Much evidence suggests that as little as 10% of the spinal cord can support substantial functional recovery. Your son is very lucky. Wise.

03-06-2004, 05:06 PM	#3
alan Senior Member Join Date: Jul 2001 Location: Baltimore, MD Posts: 6,169	I have a large hole between low C-4 and C-6, but it's apparently been stable all these years, according to MRIs. Alan "Was it over when the Germans bombed Pearl Harbor?"