Report the level, the cause (disc-osteophyte, ligamentum flavum, OPLL), the degree of canal stenosis with cord compression, and cord signal change on T2 — the surgical indication.
Orient first
- Myelopathy is a clinical diagnosis; MRI shows compression and cord injury.
- T2 hyperintensity alone is potentially reversible; T1 hypointensity suggests irreversible damage.
- OPLL is better characterised on CT.
Acquire the study
- Cervical spine MRI: sagittal T1, T2 and STIR; axial T2 at each level; axial gradient-echo for foramina.
The manoeuvre
- Sagittal T2: levels of stenosis; CSF effacement anterior and posterior to the cord.
- Axial T2 at the tightest level: cord deformation, anteroposterior cord diameter in mm, compression ratio.
- Cord signal: T2 hyperintensity (focal or diffuse) and T1 hypointensity at the same level.
- Cause: disc-osteophyte complex, ligamentum flavum buckling, OPLL, spondylolisthesis.
- Foramina: nerve root compression by level and side.
What confirms it
- Canal stenosis with cord compression and a compatible clinical picture; signal change strengthens it.
What licenses you to exclude it
- CSF preserved around the cord at every level excludes compressive myelopathy.
The classic misread
- Grading stenosis on sagittal images only.
- Missing an intrinsic cord lesion (demyelination, tumour) and calling it compressive.