Compressive myelopathy

Last revised by Dr Mostafa El-Feky on 06 Feb 2022

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

Pathology

Any cause of spinal canal stenosis including disc herniation, osteophytes, spinal osteochondroma, extradural mass, and/or paravertebral ligamentous ossification 1,2.

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 edema and ischemia 3.

These have been associated with worse outcomes: 3

  • 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

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Cases and figures

  • Case 1
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  • Case 2
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  • Case 3
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  • Case 4: due to aggressive vertebral hemangioma
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  • Case 5: due to ossified ligamentum flavum
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  • Case 6: cervical compressive myelopathy
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  • Case 7: vertebral metastasis
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  • Case 8: due to OPLL
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