Brief Answer:
need MRI films photos to help you

Detailed Answer:
Hi Lach XXXXXXX thanks for asking from HCM.


I can understand your concern. As You are continuously improving, it means you did not have permanent cord damage. The initial severe weakness was because of the cord edema and inflammation, which are subsiding continuously. So you can wait till the final regain as per your clinical improvement.

Now coming to radiological aspect i.e. MRI finding, sometimes patient might need surgery despite improvement if there is

: Unstable spine like ligament damage/sublaxation of vertebrae
: Any bony fragment inside canal
: Progressive kyphosis or scoliosis

Please send me your radiological images photos. I want to see them to advise you correctly. You can also ask your doctor about above problems.

If no such problem and you are improving, then there is no use of surgery at this time. May be in future, if you develop any symptoms, you can choose surgery.

Hope you will understand my point. If any doubt, do let me know.
Thanks. Take care

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Brief Answer:
Interpretation of MRI report and management of your cord injury

Detailed Answer:
Hi Lach XXXXXXX welcome back.

I have seen your MRI image (sagittal and axial cut). According to me,

: There are cord changes at T3 and T4 level, but it can be myelomalacia at T3 level because cord is thin at that level. At T4, thickness is normal, so it can be edema also.

: There is stenosis at same level but it is not very severe. The spinal fluid can be seen behind the cord, which is a good thing. Such type of stenosis can be managed without surgery.

Now answering to your questions

I agree partially in terms of diagnosis, according to my observation. The cord changes are not the criteria for surgery.

In your case, stenosis is not severe. It can be managed conservatively. You can wait and do exercise/physiotherapy. It will help you in regaining maximum strength.

You should also eat
: Healthy fruits/vegetables diet

: Take neuron specific vitamin supplements like B12, folic acid, pyridoxine, pentothanic acid

: You can also take S-Adenosylmethionine which helps in regeneration of neurons.

: Avoid bad posture of back.

Hope it will help you. You can wait.

If still in doubt, do let me know.
Thanks. Take care

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Brief Answer:
Myelomalacia

Detailed Answer:
Hi Lach XXXXXXX welcome back.


I understand your doubts about Myelomalacia. I can certainly say that at it is myelomalacia at T3 level. It is because myelomalacia leads to thinning of cord. It is nothing but scarring of cord after death of nerves in cord. If thinning is severe, it means more nerve death and if minimal thinning, it means less damage.

In your MRI, cord is not thin at T4 level but cord changes are present. So at T4, it can be

: Myelomalacia
: Edema or swelling/reaction
: Blood in cord

Now prognosis of edema is always better than myelomalacia/blood. And in your case, your recovery was good. Thats why, I am assuming that you had edema at T4 level and mild myelomalacia at T3 level. And nerve recovery occurs till 18 months. So if you will continue with physiotherapy, you will improve more.

Now coming to need of surgery, this myelomalacia at T3 is never going to disappear by any means. You need not to worry if you will continue with exercise. Surgery at this stage is not needed as you are improving. If stenosis has caused progressive damage, then you would not have recovered at all. You can wait till full improvement.
You should be in regular follow up. By this, you will be able to know whether any damage has started or not. If there is any progressive deterioration, you can go for surgery after fresh MRI spine. There is no need to hurry right now.

And avoid heavy load work. It can cause increase in spinal stenosis or vertebral damage. You should look for light weight work.

Hope it will clear your doubts. If still any doubt, do let me know.

Thanks. Take care

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Brief Answer:
Cord changes after injury and cause of deficit

Detailed Answer:
Hi Lach XXXXXXX welcome back.


Your symptoms were result of chronic ongoing process which was precipitated by acute injury. Because of your heavy duty work, you developed hypertrophy of spine ligaments, disc degeneration and progressive spinal stenosis.

It all lead to gradual stenosis of spine and progressive decrease in cord blood supply. This decreased blood supply lead to myelomalacia, but that acute event (happened 3 weeks ago) which caused acute injury of spinal cord, It lead to spinal cord edema. You developed symptoms only after edema, because it was sudden/more damage in short time so no adaptive mechanism of body.

You developed weakness, but as the edema settled, you started improving. Now you are improving because few temporarily damaged nerves are regenerating.

And few symptoms might persist due to myelomalacia. Myelomalacia is never sudden. It is a gradual process and it is "Scarring of spinal cord".

You should start light work activity. No problem in that. Do not do heavy weight lifting.
Be in regular follow up to know about your progress.

Hope it will clear your doubts.
Thanks. Take care

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