Myelomalacia/Osteophyte/Leg weakness

[Pepper]

I had a spinal cord AVM removed from C5 in 1988, and at that time I had a laminectomy of C3-C6.  Last year I had a corpectomy/fusion of C5-6, C6-7 due to kyphosis/herniated disc. I did ok for about 6 months, but since that time I've developed severe neck pain and left leg weakness.  My leg is really weak and stiff when I wake up, but improves with time.
I had a CT/MRI done in August and this is what the MRI showed:

There is extensive susceptibility artifact at C5, C6 and C7 from what is probably bilateral pedicle screws and an anterior plate.  The disc spaces and vertebral body heights are difficult to assess at these levels.  Vertebral body heights, and intervertebral disc spaces are otherwise normal.  There is loss of the normal cervical lordosis, with the subtle kyphotic deformity at the level of surgery.  The cervical cord is hyperintense centrally beginning at the C3 level, and extending to the C7 level.  This intramedullary process also shows a small amount of blood at C4.  As compared to prior examination, these findings have not changed, and the intra cord hyperintensity is felt to be secondary to myelomalacia or a very small developing syrinx.  The cord is not expanded.  The medulla cervical medullary junction are normal.

C4-5: Broad osteophyte with flattening of the ventral thecal sac but no signifiant central stenosis and the neural foramina are normal.  

1.  Is the leg weakness related to my neck?  Will it progress?

2.  What does the small amount of blood at C4 mean?

3.  Do myelomalacias progress?  

4.  What about the osteophyte?

[CCF-Neuro-M.D.-JT]

Without personally reviewing your films and examining you, I cannot give you accurate information regarding your case. This is especially true when I'm asked to comment on reports of imaging studies. However, I'm happy to give my best "guess" in answering your list of questions.
1.If all you have is left leg weakness then probably not. But I would be more concerned about something going on in the lumbar region (lower back) of your spinal cord. Cervical problems usually give to rise to symptoms either in the arms or arms and legs. And they're usually symmetric if it's the cord or one side if a root is compressed. Can't say if it will progress, as we don't know what's causing it. Also it's possible it's a problem in the leg itself or the right part of your brain.
2.Could be related to the prior AVM somehow (depending on if they took out all of it or just part of it) or postop findings as you've had a lot of intervention in that area. It's ijmportant to know what stage that blood is, if it's old, new, etc..
3.Wasting/softening of the spinal cord or myelomalacia can slowly progress over time, but that doesn't mean your cord wil waste away to nothing and you'll be paralyzed. It just might mean that your cord may become thinner with time.  Again I have to look at the film myself, even your radiologist said it was either myelomalacia or a small syrinx.
4.Osteophytes are usually related to degenerative joint disease that we all get as we become older. From the MRI report, it doesn't sound like it's causing any symtpoms. Wouldn't worry about it at this point.
Talk to your doctors about the MRI report. As they know you and your case, they should be of help. Best of luck.

[Pepper]

Thank you so much for your timely response, particularly on a holiday.  I have an appointment this week with my doctor.