Imaging description

Cervical myelopathy (CM) can result from extrinsic compression of the cord or cord inflammation, demyelination, ischemia, or infection. The most common reason for CM is spondylosis of the cervical spine. MRI is the modality of choice in the work-up of CM, and it can differentiate intrinsic cord lesions from extrinsic ones such as cervical spondylosis. In patients with CM secondary to cervical spondylotic changes, MRI shows narrowing of the spinal canal, complete effacement of the CSF spaces at the stenotic level(s), and deformity of the cord, although presence of these findings does not always predict clinically detectable CM. Although the primary mechanism of cervical spondylotic myelopathy is the compression of nervous tissue, there is some evidence that ischemia at the cellular level may be a contributing factor [1].

Increased T2 signal within the cord at the level of compression can be seen in some patients and heralds a worse outcome after surgical decompression compared to patients who do not have increased T2 signal in their cords [2]. Other factors that are associated with lack or diminished levels of improvement following surgery include old age, longer duration of symptoms, diminished T1 signal in the cord, and worse preoperative neurologic status [2–4].