MRI Images and Tethered Cord

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MRI Images and Tethered Cord

Postby streetsense » Wed Aug 27, 2008 8:09 pm

As someone who suffers from post-traumatic SM, I have often looked to find more info on how tethered cord is diagnosed from MRI images. If anyone has a good link to something that shows the typical imaging that illustrates TC on an MRI image, I'd be glad to know what it is.

Some argue that any PTSM is likely to have some degree of TC, almost by definition. I think the jury is still out on that, butit does make some sense that an injury will often cause scar tissue to form, frequently leading to TC.

I've yet to be seen by any doctor with the specialization to properly assess my spinal issues. I am being tended to by several people who at least understand that SM is nothing to be dismissed as inconsequential. A recent change in meds has helped me more than anything else in almost a year since my SM diagnosis after decades of seeing docs who were either clueless or who put the interests of others ahead of my health. I'll write more about the med change soon, but I wanted to fully assess the help it's been and the limitations of that help, so that the info is helpful to others.

In general, the central nervous system pain that suffused my spinal cord has been considerably alleviated. I've been able to almost do without the hydrocodone that was messing up my digestive system with constipation, but which provided only partial relief for my CNS pain. The only thing I take it for is when I can't get to sleep at night.

This is caused by my tailbone hurting, as if someone has stepped on it or kicked me right above what would be my plumber's butt, if I wasn't careful to wear a suitable shirt. :oops:

This pain would have been a mystery to me if the NL I recently started seeing hadn't pointed out some issues way down at the tail end of my spine. I thought little of it, until the recent med change. Trying to quit the hydrocodone was very easy with the new med, except that I started getting that darn pain down there once I laid down and tried to get to sleep. It's very disconcerting to have a pretty good day, then to try to get to sleep only to have this problem crop up.

The other day, we had a thread that asked people to show some representative MRI images. I posted several, but I'll only repeat two of them here. The first is one that shows where my syrinx is located, centered around T7-8. It extends upwards a couple of vertebrae. Depending on the image, it can extend downward a couple of vertebrae, in some images, or even much further, as in this image:
Image

Then there is the image of the funky tailbone:
Image

The first seems to show my spinal cord "pulled toward the front" of the intraspinal space. The second seems to show my spinal cord "pulled toward the back" of the intraspinal space. It also has a twisted braided look to it. I realize that this is not the spinal cord itself down that low, but the terminal attachment that those who have TC surgery mention as releasing pressure when it is cut to allow their spinal cord to float freely in the intraspinal space.

Does TC show up in images as this "pulling" toward the front or the back of the intraspinal space?

Is the twisted, braided look in the second image, along with the fact that it seems to run along the backside of the intraspinal space another indication of TC?

In both cases, it looks like my spinal cord is trying to take the shortest path between two points, perhaps because of the tension created by TC. Is this how it's diagnosed or am I mistaken?

Finally can anyone direct us to something that shows how TC looks in MRI images, presuming that maybe my images do not show TC?
Thanks!
Last edited by streetsense on Wed Aug 27, 2008 11:46 pm, edited 1 time in total.
streetsense
SM 7mm T-5 to T-10 with less clearly defined extension down through the lumbar vertebrae
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Re: MRI Images and Tehtered Cord

Postby donny » Wed Aug 27, 2008 8:55 pm

Hi, The traditional tethered cord can be seen on mri imaging, the conus will end below L-2 probably between L-2 and L-3,
The accult tethered cord which I believe is what your refering too I dont believe it is seen on mri imaging at least not at the lumbar spine. I do believe tci measures the brain stem and if this is longer than what it should be there is an indication that you have otc. The brain stem will vary in length according to your own personal height. in other words someone who is 7 feet tall will have a longer brain stem than a person who is 5 feet tall.
A urodynamics test is very usefull to find out if you have a neurogenic bladder. the pulling effect causes problems in the area of the conus which has a lot of nerves going through them which effects bladder functions. of course a thourogh neurological exam.
I may be wrong on this stuff but this is what i understanding of it.
Take care
Don
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Re: MRI Images and Tethered Cord

Postby wendi » Thu Aug 28, 2008 7:48 am

That is true Don. Besides all my "yes" answers on the TC sheet, Dr B said I had the brainstem of a 6' tall man. I am 5'4". This was his indication that I had TC. When they did my surgery, the fantail thing was not moving and I had very little CSF flow in that area.

I am not very good at reading MRI's so I won't comment.

It is always nice to hear from you Streetsense.

Wendi in PA
ACM 7.5mm B4 TCS 2.4mm post op
TC ,TCS @ TCI on 1/3/08,
chronic sacrolitis
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Re: MRI Images and Tethered Cord

Postby Janice » Thu Aug 28, 2008 10:37 am

Hi SS,

I think it's a terrific to explore the idea of TC. I wish I could tell by your MRI, if you had it but I wouldn't know what to look for. Don has provided some great information and, as Wendi mentioned, you should take the test on TCI's website to see how many "yes" answers you come up with. It's listed under patient forms, I think, and it's the TC screening tool.

It definitely couldn't hurt for you to explore this with your doctor. I hope someone will chime in with knowledge of what TC looks like on an MRI. You just might have post-traumatic tethered cord, as described on "Craig's Hospital".

Are you having any bladder and/or bowel incontinence? This is pretty much a solid indicator. I can't recall for sure but I think most of the questions on the TC questionnaire are focused on incontinence.

Take care and speak to your doctor about this and let us know the outcome. I'd also like to know the name of the med that's helping you, when you're ready to post about it.

P.S. LFRM, once posted an article on OTC, or TC, I can't recall, but maybe she will chime in and be able to help you out. I think her post included links with images. I also think there was mention of the cord ending below L2. I can't find the post but if I do, I'll add the link. For some reason, I'm thinking this post might have the information you're looking for.
GOD Bless!
Janice

Thoracic: SM T3-T12 / Disc Buldge T7-T9 / Mild Scoliosis
Cervical: SM C2-C6 / DDD / Kyphosis
Hemangioma's: T9-T11 & L4

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Re: MRI Images and Tethered Cord

Postby streetsense » Thu Aug 28, 2008 12:28 pm

Everyone,
Thanks for the info and support. Here's an image of a cervical MRI taken where they were checking to see if CM was an issue for me. They told me no, but since there's probably more expertise here than with any of my doctors, I'm always open to a second opinion :D

Also, I'm 6' 2" tall, if that helps anyone hazard a guess.

I suspect that how the brain stem is relevant in TC is in terms of how much it is "stretched" or made thinner in comparison to the spinal cord itself. There is definitely a pinched look to things as they exit the base of my skull. So I welcome your opinions on this, one way or another:
Image
streetsense
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Re: MRI Images and Tethered Cord

Postby Janice » Thu Aug 28, 2008 1:07 pm

I think you're probably moving in the right direction in seeing if your doctor can determine if there is OTC or CM0, involvement with your case.

The tonsils appear to be a little low lying and there also appears to be crowding at the base of the skull. I'm not sure about the "stretched" look. Would that be your perspective of crowding? If not, then again, I'm not sure.

Take care, and definitely explore this information with your doctor.
GOD Bless!
Janice

Thoracic: SM T3-T12 / Disc Buldge T7-T9 / Mild Scoliosis
Cervical: SM C2-C6 / DDD / Kyphosis
Hemangioma's: T9-T11 & L4

http://janice-mylifewithsm.blogspot.com/ (Copy & Paste link into your browser)
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Re: MRI Images and Tethered Cord

Postby streetsense » Thu Aug 28, 2008 3:52 pm

Janice,
I suspect that there is some crowding at the top of my spinal cord, from this and other images I haven't posted, plus many of the symptoms I have.

The "stretched" look I refer to is below that in the third image above. If you look at the level of the "50" mark on the scale on the right side of the cervical image and trace it upward, the spinal cord takes on an hourglass shape, going from wide where it attaches to the bottom of the brainstem to narrow back to wide again within the first 50mm or so of its departure downward from the brainstem.

As for TCI's TC screening tool, I do have a number of issues it mentions. I don't have incontinence, but I do have trouble getting the stream started, then being able to completely empty my bladder; sometimes leakage of stools; the low back pain is actually that right in my tailbone and very recent, if that fits; and my leg pain is mostly confined to my left leg and may simply be Raynauds', but I frequently get the numbness on the bottom of both feet, although it's worse on the left.

So maybe that's enough to fit, but I can't say for certain that this confirms TC. I also have kidney stones, which may fit with a backing up of urine into my kidneys from my bladder. It can get quite full before I need to pee, but then once it's started, I feel the need for frequent urination. The filum terminale does look like it's under tension in the second image above, which is one reason why I'm thinking that it may be evidence of TC. However, the conus medllaris looks in an image I haven't posted as if it is located above the L2-L3 disc line that is the typical definition of TC, in fact about in the middle of L2, so it would be OTC by Dr. B's definition if it is TC.

Now let's consider the T7-8 issue, where my syrinx is centered. Dr. B notes in the video how the prone on the back MRI will show how the end of the spinal cord and filum terminale will float down against the back/downward part of the dura if it is not under tension. That looks to be the case here. It does that. But as the first image shows with regard to T7-8, the spinal cord does not float down. Instead, it looks like it is attached on the upside, the part that is next to the bulging disc there. Assuming that the same floating to the bottom would happen, then this could be another clue of TC due to PTSM at T7-8.

Hmmm, lots to consider that really isn't obvious, thus there's a good reason why TCI use a scoring grid to determine if enough evidence exists to diagnose TC or OTC.
streetsense
SM 7mm T-5 to T-10 with less clearly defined extension down through the lumbar vertebrae
sleep apnea
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Re: MRI Images and Tethered Cord

Postby Janice » Thu Aug 28, 2008 6:39 pm

When are you going to have the chance to speak with your doctor about this?
GOD Bless!
Janice

Thoracic: SM T3-T12 / Disc Buldge T7-T9 / Mild Scoliosis
Cervical: SM C2-C6 / DDD / Kyphosis
Hemangioma's: T9-T11 & L4

http://janice-mylifewithsm.blogspot.com/ (Copy & Paste link into your browser)
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Re: MRI Images and Tethered Cord

Postby streetsense » Thu Aug 28, 2008 9:49 pm

Janice,
I'll be seeing my NL in a couple of weeks. I'm not really sure where that's going to go. He did a very thorough evaluation, which impressed me considering how little you get that from any doctor these days. I may inquire about the NIH study after that, but the more I find out about my condition the less I think it's actually clear of craniocervical junction abnormalities. Still, they may be interested.

He also put me on Topamax, which was virtually worthless, but whose manufacturer apparently feel is worth it's weight in gold. I quit it at the end of the script. And he tried to set me up with a sleep study. They didn't even bother calling me after they found out my insurance wouldn't cover it. So I did the best I could with what he recommeneded.

And then there's my new med, prescribed by a palliative care specialist, which has done more in the last few weeks than anything else in the last year. Considering how no one can offer me any better solutions to this point, I'm very glad to have someone willing to work with me to at least effectively limit the pain I'm in.

More on this soon...
streetsense
SM 7mm T-5 to T-10 with less clearly defined extension down through the lumbar vertebrae
sleep apnea
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Re: MRI Images and Tethered Cord

Postby wendi » Fri Aug 29, 2008 8:13 am

Hi Streetsense:

One thing you may want to consider is sending your MRI image by email to Dr B. Even tho he is extemely busy, he still reads and responds to emails. He has told others here from other countries that they had cm. I am sure he could look at your MRI and tell you if he suspects TC. Just a thought.

Take care,
Wendi in PA
ACM 7.5mm B4 TCS 2.4mm post op
TC ,TCS @ TCI on 1/3/08,
chronic sacrolitis
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Re: MRI Images and Tethered Cord

Postby streetsense » Fri Aug 29, 2008 2:22 pm

Wendi,
Thanks for the suggestion. I just may do that after my upcoming NL visit. I rather expect it to be inconclusive as far as CM is concerned, but my NL did a bunch of testing that will rule out many things. Among the things that these tests should rule out are MS, epilepsy, and diabetes. AFAIK, none of these are issues, although those are the first things that doctors tend to think of when you start listing your symptoms. I plan on taking the relevant images in so that I can attention to things that seem to suggest TC. Not that I'm expecting a definitive answer on things.
streetsense
SM 7mm T-5 to T-10 with less clearly defined extension down through the lumbar vertebrae
sleep apnea
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Re: MRI Images and Tethered Cord

Postby wendi » Tue Sep 02, 2008 7:45 am

Good Luck with that and let us know how it goes.

Wendi
ACM 7.5mm B4 TCS 2.4mm post op
TC ,TCS @ TCI on 1/3/08,
chronic sacrolitis
wendi
 
Posts: 3346
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