The main causes of acute non-traumatic myelopathy are spinal cord compression and transverse myelitis. Although it remains accepted that urgent imaging is required to exclude compression, in practice most patients referred are already paraplegic and have little prospect of useful recovery.
MRI is by far the preferred imaging modality because it is more sensitive and much more specific than myelography for the range of pathologies, both inside and outside the spinal cord, that may be shown.
MRI of the cervical spine in an elderly woman with severe head and neck pain, and sudden onset of paraplegia. On the T 2-weighted sagittal image a high signal is present in the C5-6 and C6-7 intervertebral discs, and there is a soft tissue mass elevating the posterior longitudinal ligament. The spinal cord is compressed and returns hazy increased signal. This was an extradural abscess secondary to discovertebral osteomyelitis (old infarcts are also visible in the ventral part of the pons).
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