There is a broad spectrum of causes of compressive myelopathies. Resulting neurologic deficits may not improve after decompression. Early diagnosis and treatment are paramount to ensuring long-term functional outcome, and errors in diagnosis with resultant delays in treatment can have drastic consequences. The history, including patient demographics and the onset and progression of the disease, and physical examination are critical tools in arriving at a correct diagnosis. Very often, the diagnosis is obvious.
After the history and physical examination have concluded that a myelopathy is present, imaging is necessary to evaluate for a compressive etiology. Spinal MRI, including gadolinium-enhanced images, is the diagnostic study of choice and should be obtained expediently. Major advantages of MRI include its multiplanar capabilities and the ability to visualize nonosseous lesions.
Dependent on MRI findings, other radiologic evaluations may be necessary, including noncontrast CT and plain x-rays. If an MRI is not obtainable because of the presence of a pacemaker, claustrophobia, lack of availability, clinical situation, or a multitude of other possible reasons, CT myelography is an excellent alternative tool. Plain myelography can help in defining a compressive lesion. The goal of imaging studies is to define the lesion and guide surgical decision making if cord compression is found.