♦ Plain X-rays may demonstrate destruction and/or collapse of a vertebra. Changes are sometimes more subtle e.g. loss of a vertebral pedicle. Paravertebral masses may sometimes also be shown. In 15-20% of cases, plain films show no abnormality.

♦ MRI scanning is the investigation of choice. It will demonstrate the site and extent of the lesion and presence of multiple lesions in vertebrae and in the spinal canal. It is particularly useful in cases of cauda equina syndrome.

♦ MRI has largely superseded myelography. Where MRI is not available, myelography will show the anatomical location of a spinal cord lesion and whether a block is complete or not. However, if a complete block is present the upper limit of a lesion may not be demonstrated without cisternal myelography.

♦ CT scanning may provide useful information if MRI is not available. Simultaneous myelography may enhance the usefulness of the investigation. It will demonstrate an abnormality within a defined region of the cord but is not an ideal primary investigation if the site of compression cannot be accurately predicted from clinical and plain radiograph findings.

If radiotherapy or surgery is proposed, it is useful to ask the radiologist to mark the level(s) of the lesion(s) on the patient's skin, to aid localization.

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