Myelomalacia is a spinal cord disorder.
What is Myelomalacia?
The myelomalacia definition, strictly speaking is the “softening of the spinal cord”. After an acute injury, bleeding of the spinal cord may occur.1 As a result, there is “subsequent softening of normal tissues”. Myelomalacia can be caused by trauma or disease, but if it worsens, and if the bleeding reaches the cervical region of the body, it can be fatal. Bleeding can make the tissue necrotic. Fractured vertebrae can lead to bleeding in the spinal cord, as can some back surgery. Osteoporosis may also contribute to spinal instability and hemorrhaging. Sometimes circulatory problems can lead to a deterioration of tissues and bleeding.2 Myelomalacia can progress into impairment in the functioning of the lower extremities, below-normal or absent reflexes of the anus and pelvic limbs, loss of pain perception in the caudal region (near the coccyx), depression, respiratory problems due to “diaphragmatic paralysis”, and even neurological issues. Death could result from the respiratory paralysis. Damage occurs to the central nervous system. At first, the spinal cord damage may be minor. The most commonly injured areas are the lumbar spine (lower back) and cervical vertebrae (upper spine area).3
Myelomalacia Symptoms and Diagnosis
Some of the early symptoms of this disorder could be hypertension, extremities losing motor functions, or jerking limbs. Later, patients may move from the lack of reflexes to being unable to feel pain, or they might become paralyzed. These symptoms would indicate that the spinal cord has been damaged or softened. Once the respiratory system is paralyzed, the patient would die. While the elderly are at risk of myelomalacia due to weakened bones (osteopenia), damage to the spinal cord can happen to anyone. Hemorrhaging may lead to compression, further harming the spinal cord. Athletes can also develop this condition, due to injuries or accidents, such as taking frequent hits or landing on the ground in a harsh manner.4 Over time, patients might have a loss of bladder or bowel control, if not complete paralysis. Damage can ascend upward, even if it starts in the lumbar region. Myelomalacia is often diagnosed with myelography testing or MRI.5 MRI, or magnetic resonance imaging, is a radiological technique that can view the body’s internal structures. The MRI can show where bone density is lost and could demonstrate the onset or the progression of the myelomalacia in the patient.6 Myelography “uses a contrast medium to detect pathology of the spinal cord, including the location of a spinal cord injury”. It uses X-rays.7
Cervical myelomalacia is a degenerative spinal condition that is defined as “softening of the spinal cord in the upper spine”. This occurs due to insufficiency in the blood supply that feeds the spinal cord. Cervical myelomalacia may be caused by aging or from sports injuries. For patients seeking surgical treatment, “a minimally invasive procedure for cervical myelomalacia does offer a number of benefits over traditional open spine surgery”, but this is still a serious procedure to undergo. The MIS (minimally invasive stabilization) procedures typically are offered in an “outpatient setting”, with a “small incision”. During the procedure, the bone or disc that is softening or constricting the spinal cord is taken out. In the remaining space, “an implant, bone graft, and the patient’s own stem cells are inserted” to replace the damaged disc. After the surgery, the 4-6 week period following the procedure is “crucial for rehabilitation”. Patients should not overexert, twist, bend or lift, but they should become mobile.8
Early Diagnosis and Surgery
It is important to remember that surgery may only slow or stop the damage from becoming worse, since “there is no known treatment to reverse nerve damage due to myelomalacia”.9 Surgery is the typically recommended treatment for myelomalacia because a damaged spinal cord does not grow back and recovery is impacted by atrophied and tightened muscles. If a patient is of an advanced age, or if they have a health condition that would contraindicate surgery, then they might be prescribed steroids to reduce swelling or baclofen (a muscle relaxer) to decrease spasticity. In general, though, these prescriptions, as well as pain medications, are said to “work best in conjunction with surgery”.10 Treatment is generally designed to prevent further damage, although “early stage myelomalacia may be reversible”, depending on the severity of the spinal cord damaged. That is why it is important to get an MRI as soon as possible so that the condition can be assessed and managed quickly.11 Furthermore, the MRI is preferred over a CT (computerized tomography) scan, because it is more accurate in demonstrating the “intramedullary abnormalities in the injured spinal cord”, since MRI can “separate myelomalacia from a posttraumatic spinal cord cyst”. It is important to distinguish “prior to surgery, patients with shuntable intramedullary cysts from those with chronically damaged but noncystic spinal cords”. In other words, the MRI gives a more accurate picture than the CT scan in patients with myelomalacia versus those with a “posttraumatic spinal cord cyst”.12
1, 3, 4, 6, 9 https://en.wikipedia.org/wiki/Myelomalacia
2, 5 https://www.causes.com/causes/335827-for-truthful-information-about-meningeal-pathologies-sacral-cysts-and-arachnoiditis/updates/432607-myelomalacia-severe-problem-due-to-a-bleeding-in-the-spinal-cord