CT Spine CT can depict bony encroachment on the spinal canal in cases of disc-osteophyte complexes as well as subluxation and compression of neural structures by herniated disc material with better resolution than with radiographs. For inflammatory or infectious processes, CT can be beneficial to evaluate the osseous structures and adjacent soft- tissue involvement [75]. Although CT demonstrates osseous integrity with excellent assessment of bone destruction, MRI provides better visualization of the marrow and the spinal cord [13-15]. CT of the spine is not useful in the initial evaluation of spinal cord ischemia [76]. CTA Spine There is no relevant literature regarding the use of CT angiography (CTA) in the initial imaging evaluation of acute onset myelopathy. In cases of spinal cord ischemia, CTA can be used to identify the artery of Adamkiewicz or vertebral artery dissection/occlusion and should be considered as a follow-up to MRI [12]. Myelopathy Radiography Spine There is no relevant literature supporting the use of radiographs as the initial imaging evaluation of acute onset myelopathy. Although radiographs may demonstrate bone destruction, CT provides better visualization of the osseous spine [13-15]. In spondylotic myelopathy, radiographs may depict osteophytic narrowing of the spinal canal, whereas conventional myelography can be used to diagnose severe canal stenosis [74]. MRI, however, is best for evaluation of the marrow and the spinal canal/spinal cord [13-15]. Lateral radiographs can be obtained as an adjunct to cross-sectional imaging to help assess alignment parameters and dynamic instability [77]. Arteriography There is no relevant literature regarding the use of conventional arteriography in the initial imaging evaluation of acute onset myelopathy. Even in cases of spinal cord ischemia and suspected spinal vascular malformations, conventional arteriography of the spine is not useful for initial evaluation [71,76]. Variant 2: Chronic or progressive myelopathy. Initial imaging.
Myelopathy PCAs. CT Spine CT can depict bony encroachment on the spinal canal in cases of disc-osteophyte complexes as well as subluxation and compression of neural structures by herniated disc material with better resolution than with radiographs. For inflammatory or infectious processes, CT can be beneficial to evaluate the osseous structures and adjacent soft- tissue involvement [75]. Although CT demonstrates osseous integrity with excellent assessment of bone destruction, MRI provides better visualization of the marrow and the spinal cord [13-15]. CT of the spine is not useful in the initial evaluation of spinal cord ischemia [76]. CTA Spine There is no relevant literature regarding the use of CT angiography (CTA) in the initial imaging evaluation of acute onset myelopathy. In cases of spinal cord ischemia, CTA can be used to identify the artery of Adamkiewicz or vertebral artery dissection/occlusion and should be considered as a follow-up to MRI [12]. Myelopathy Radiography Spine There is no relevant literature supporting the use of radiographs as the initial imaging evaluation of acute onset myelopathy. Although radiographs may demonstrate bone destruction, CT provides better visualization of the osseous spine [13-15]. In spondylotic myelopathy, radiographs may depict osteophytic narrowing of the spinal canal, whereas conventional myelography can be used to diagnose severe canal stenosis [74]. MRI, however, is best for evaluation of the marrow and the spinal canal/spinal cord [13-15]. Lateral radiographs can be obtained as an adjunct to cross-sectional imaging to help assess alignment parameters and dynamic instability [77]. Arteriography There is no relevant literature regarding the use of conventional arteriography in the initial imaging evaluation of acute onset myelopathy. Even in cases of spinal cord ischemia and suspected spinal vascular malformations, conventional arteriography of the spine is not useful for initial evaluation [71,76]. Variant 2: Chronic or progressive myelopathy. Initial imaging.