Radiological approach to non-compressive myelopathies

Abstract

Abstract Background Myelopathy, a pathological condition related to the spinal cord can broadly be categorized into compressive and non-compressive aetiologies. Magnetic resonance imaging remains the modality of choice when suspecting non-compressive myelopathy as it helps to localize the affected segment and exclude compression as the cause of myelopathy. This review deals with the imaging approach for non-compressive myelopathies. Main body Demyelinating disorders are the most common cause of non-compressive myelopathy and often show confounding features. Other causes include inflammatory, ischemic, metabolic, and neoplastic disorders. Non-compressive myelopathy can broadly be classified into acute and non-acute onset which can further be categorized according to the distribution of the signal abnormalities, including length of cord involvement, specific tract involvement, enhancement pattern, and the region of the spinal cord that is affected. Conclusions Imaging plays a critical role in the evaluation of clinically suspected cases of myelopathy and MR imaging (with or without contrast) remains the preferred modality. Compressive causes must be excluded as a cause of myelopathy. Despite a multitude of causes, the most common imaging appearance is a nonspecific T2 hyperintense signal in the spinal cord, and thus, a pragmatic diagnostic approach along with appropriate clinical and biochemical correlation is essential for arriving at an accurate diagnosis.