Compressive myelopathy refers to neurological deficits that result from compression of the spinal cord. It most commonly occurs in the cervical spinal cord.
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Pathology
Any cause of spinal canal stenosis including cervical spondylosis (endplate changes, disc herniation, osteophytes, facet joint arthropathy, ligamentum flavum hypertrophy), spinal osteochondroma, extradural mass, paravertebral ligamentous ossification, and congested epidural veins 1,2.
Cervical spondylosis frequently causes chronic myelomalacic changes of the spinal cord and rarely causes acute spinal cord oedema 5.
Radiographic features
MRI
Intramedullary T2 hyperintense signal in the setting of symptoms of acute cord compression is an urgent finding and probably indicates acute cord oedema and ischaemia 3. Meanwhile, myelomalacic changes of the spine has a typical "owl-eyes sign" on T2-weighted images 5.
high T2 signal intensity in a compressed segment relative to a non-compressed segment
low T1 signal intensity change with high T2 signal intensity at the compressed segment
administration of contrast is helpful in excluding other causes such as spine infection, tumour, demyelinating disease, and vascular malformations. However, gadolinium enhancement is present in 7.3% of cervical myelopathy cases 4.
Treatment and prognosis
These findings have been associated with worse outcomes 3.
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