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Myelomalacia - definition

Myelomalacia "my-ello-ma-lay-sha"

Myelo [‘spinal cord’] malacia [‘softening’] is a descriptive term for changes seen within the spinal cord on MRI images which indicate a loss of spinal cord volume. As a descriptive term there are a variety of disease processes which can cause this and it would generally be considered a significant finding, as the spinal cord does not repair itself readily, and therefore loss of spinal cord tissue is permanent.

What is the relevance to CSM?´╗┐´╗┐

CSM can cause myelomalacia. Before spinal cord volume loss can be seen, often oedema can be detected by the MRI. Therefore, the presence of oedema in CSM is often considered a critical finding.

What does Dr Mark Kotter think?

What does the latest evidence suggest?

Whilst as Dr Mark Kotter informs us, the presence or absence of myelomalacia should not be used to define when surgery should occur (historically the absence of a ‘white spot’ on the MRI might have lead to watch and wait approach), its presence and extent may be related to prognosis. Findings from an extensive review of the literature in 2013 [1] suggested that the presence of myelomalacia and its extent may be associated with a poorer outcome after surgery. However these researchers considered this specifically in a subsequent study [2] and found that this was not the case.

Conclusions

At the moment, we can safely say the presence of myelomalacia is a potential sign on MRI of CSM. However it should not be used to define the timing of surgery. It is unclear whether or not it predicts outcome, but the recent findings would suggest this is not the case.

References

1. Tetreault et al. Spine A systematic review of MRI Characteristics that affect treatment decision making and predict clinical outcomes in patients with cervical spondylotic myelopathy Aug 2013
2. Fehlings et al. Global Spine Journal A clinical prediction rule for clinical outcomes in patients undergoing surgery for degenerative cervical myelopathy: analysis of an international AOSpine prospective multicenter data set of 743 subjects. May 2015