The body regions covered in this clinical scenario are cervical, thoracic, and lumbar spine. These body regions might be evaluated separately or in combination as guided by physical examination findings, patient history, and other available information, including prior imaging. Once extrinsic compression of the spinal cord has been excluded, chronic or progressive myelopathy can be subdivided into non-neoplastic and neoplastic causes. Non-neoplastic causes include demyelinating diseases such as MS, NMO, and ADEM; metabolic derangements such as Vitamin B12 (cobalamin) deficiency, copper deficiency, and nitrous oxide inhalation; chronic infections including human T cell lymphotropic virus myelitis, tuberculosis, schistosomiasis, human immunodeficiency virus vacuolar myelopathy, and tertiary syphilis; prior radiation treatment; autoimmune causes including paraneoplastic myelopathy; and vascular abnormalities such as spinal dural AVM/fistulas. Neoplastic causes include primary and metastatic tumors of the spinal cord. MRI Spine MRI is useful for evaluation of the spinal cord when investigating the etiology of chronic or progressive myelopathy [32]. MRI has superior soft-tissue resolution and multiplanar capability, making it ideal for evaluation of the spinal canal and its contents as well as the surrounding osseous and soft-tissue structures [13-15,33-36]. The imaging changes in the spinal cord due to myelomalacia and gliosis are best discerned by MRI [81,82]. Intramedullary cord signal changes on MRI in patients with spondylotic myelopathy represent prognostic factors for neurosurgical outcome [21,37-41]. IV contrast is typically not required for the diagnosis of spondylotic myelopathy, but characteristic patterns of enhancement can be seen immediately at and below a level of stenosis [42,43].
Myelopathy PCAs. The body regions covered in this clinical scenario are cervical, thoracic, and lumbar spine. These body regions might be evaluated separately or in combination as guided by physical examination findings, patient history, and other available information, including prior imaging. Once extrinsic compression of the spinal cord has been excluded, chronic or progressive myelopathy can be subdivided into non-neoplastic and neoplastic causes. Non-neoplastic causes include demyelinating diseases such as MS, NMO, and ADEM; metabolic derangements such as Vitamin B12 (cobalamin) deficiency, copper deficiency, and nitrous oxide inhalation; chronic infections including human T cell lymphotropic virus myelitis, tuberculosis, schistosomiasis, human immunodeficiency virus vacuolar myelopathy, and tertiary syphilis; prior radiation treatment; autoimmune causes including paraneoplastic myelopathy; and vascular abnormalities such as spinal dural AVM/fistulas. Neoplastic causes include primary and metastatic tumors of the spinal cord. MRI Spine MRI is useful for evaluation of the spinal cord when investigating the etiology of chronic or progressive myelopathy [32]. MRI has superior soft-tissue resolution and multiplanar capability, making it ideal for evaluation of the spinal canal and its contents as well as the surrounding osseous and soft-tissue structures [13-15,33-36]. The imaging changes in the spinal cord due to myelomalacia and gliosis are best discerned by MRI [81,82]. Intramedullary cord signal changes on MRI in patients with spondylotic myelopathy represent prognostic factors for neurosurgical outcome [21,37-41]. IV contrast is typically not required for the diagnosis of spondylotic myelopathy, but characteristic patterns of enhancement can be seen immediately at and below a level of stenosis [42,43].