Compressive myelopathy

Last revised by Adrià Roset Altadill on 21 May 2024

Compressive myelopathy refers to neurological deficits that result from compression of the spinal cord. It most commonly occurs in the cervical spinal cord. 

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 edema 5.

Intramedullary T2 hyperintense signal in the setting of symptoms of acute cord compression is an urgent finding and probably indicates acute cord edema and ischemia 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, tumor, demyelinating disease, and vascular malformations. However, gadolinium enhancement is present in 7.3% of cervical myelopathy cases 4.

These findings have been associated with worse outcomes 3.

ADVERTISEMENT: Supporters see fewer/no ads