This Is MS Multiple Sclerosis Knowledge & Support Community

uprightdoc wrote:Robert,
Your scans are very interesting. Look at the shape of the vertebrae in you lumbar spine. They should basically be square in shape. In your scans the tops and bottoms of the vertebrae case show significant compression deformation. You also have buckling of the ligament flavum that is almost compressing the cord in the area you drew the circle around.

Thx doc,

Question, ligament flavum.....is that the right Side? Aka.....i dont knows exactly what you mean

The ligamentum flavum connects the lamina portion and joint capules of the spine. The lamina and joint capsules form an arch over the rear (posterior) side of the spinal cord. The ligamentus flavum is located behind the spinal cord. Degeneration and buckling of the ligament can invade the spinal canal and cause stenosis and compression of the cord. It also causes compression of the epidural vertebral veins that drain the cord.

Thx, that is getting clearer. I dont see them in the image, but i will look at the mri again
Is it treatable?

Hi Doc,

I got another question; on the larger image, i see a dark line next to the cord and white space..on the right, upper part, what's that?

Robnl wrote:Hi Doc,

I got another question; on the larger image, i see a dark line next to the cord and white space..on the right, upper part, what's that?

I think i know; the cord lies somewhat deeper, behind the fluïd...

The straight dark line is part of the ligamentum flavum. The white area next to the cord is the subarachnoid space of the cord and the epidural space of the spinal canal. There are different methods that neurosurgeons use to correct stenosis. Endoscopic surgery is a good option for correcting stenosis. It is minimally invasive and done with local anesthesia. In most cases patients go home after surgery.

Ok, thx..

So, why is the cord thick an then thin if it's totally visible (still a bit confused, sorry )

A radiologist would be able to determine if there is atrophy (decrease in size) or edema (swelling) of the cord. The wide part is probably the normal lumbar enlargement of the cord. What is clear to me however, is the deformed shape of the fluid space around the cord due to the spondylosis and stenosis, which is affecting the appearance of the cord. The cord is displaced within canal. The space around the cord is called the epidural space. The epidural space contains the vertebral veins. Spondylosis and stenosis affect venous flow through the epidural veins which can affect blood supply to the cord. Spondylosis, stenosis and compressed vertebral veins can also affect CSF flow.

I would like to add my 2c worth on these images.

I was concerned with my own MRI's regarding the impression that the cord was mis-shaped and the available space around or in the bone structure, it's clearances. The answer was that the image is a straight line slice through the area and doesn't follow the line or alignment of the spine. So what I realised is that it isn't parallel with the cords position, meaning that if there is a curve in the spine then the slice will not be 'dead centre' of cord.

Hope this makes some sense. The cord can appear to be thicker in sections and thinner in other because of the image but it is not showing the true centre or the off centre of the cord along it's length within the bones in the image.


Nigel

I didn't read everyone's conversation but what I picked up in a skim is that the discussion is about vertebral cord compression and fluid restriction. I saw my MRI and at C5 I have an active lesion. C5 is compressing my cord-easily visible on MRI. Over the last few years my chiropractor noticed my C5 was out of alignment. I wasn't dx then and didn't have symptoms either. I asked my doctor while we were viewing the MRI if the lesion could be related to the C5, and he said no. Im not going to rule it out. I am recently diagnosed with minimal symptoms and considering ccsvi. I think some docs need to look outside the box and consider other causes of MS.

Hi Nigel,

That's also what i thought, that the cord bends a little to the left, to t the right etc.

Thx

But where i drew the circle its a bit weird dont you think?

Robert,
The curvature of the spine is not the cause of the difference in appearance of thickness of the cord in your case. You have a loss of normal curvature of the lower spine. It is too straight. The area you circled is not normal and it is not caused by the curvature of the spine. What you see is spondylosis causing significant stenosis most likely due to degeneration of the ligamentum flavum in the posterior aspect of the spinal canal. The enlarged area of the cord you see is called the lumbar enlargement and cauda equina.

http://en.wikipedia.org/wiki/Lumbar_enlargement
http://neuroscience.uth.tmc.edu/s2/chapter03.html

Great links, doc!

Great to discuss this with you guys..and to hear opnions! Speak out your thoughts, always interesting.
The doc can and will explain

I'm grateful for that!

I would still like to know why your spine is damaged and compressed the way it is. Being sedentary due to MS can cause the spine and cartilage to degenerate due to different structural loads and decreased blood flow etc. The degeneration in your spine, however, doesn't look like it is due to sitting too much. The only thing I recall you mentioning that may have caused that type of degeneration is that you played soccer. Falls onto the buttocks could explain the deformation in your spine. Heading the ball could similarly cause compression injuries of the cervical spine.

should i see something like this in my case (ligamentum flavum)?

Gonna check my mri again tomorrow...


And;
http://www.ajnr.org/content/31/10/1813.full