Spinal Cord Compression (Suspected)
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Population Covered By The Guidance
This pathway provides guidance on the imaging of adult patients with suspected acute spinal cord compression.
Date reviewed: April 2018
Date of next review: May 2023
Published: June 2018
Quick User Guide
Move the mouse cursor over the PINK text boxes inside the flow chart to bring up a pop up box with salient points.
Clicking on the PINK text box will bring up the full text.
The relative radiation level (RRL) of each imaging investigation is displayed in the pop up box.
| SYMBOL | RRL | EFFECTIVE DOSE RANGE |
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None | 0 |
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Minimal | < 1 millisieverts |
 |
Low | 1-5 mSv |
 |
Medium | 5-10 mSv |
 |
High | >10 mSv |
Images
Image GalleryNote: These images open in a new page |
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|---|---|---|
| 1a |  |
Cervical Spinal Stenosis Image 1a and 1b (Magnetic Resonance Imaging): Severe spinal stenosis at C3/4 with complete effacement of the CSF space around the cord (arrow). There is high signal within the cord distal to the stenosis which may reflect cord oedema. Mild spinal stenosis at C5/6 and C6/7 (arrows) are also present. |
| 1b |  |
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Teaching Points
Teaching Points
- A detailed history and thorough clinical examination is required prior to imaging
- Patients should be urgently assessed by a senior clinician, which includes emergency or medical physicians and surgeons
- MRI is the first line modality in the assessment of suspected spinal cord compression
- If MRI is contraindicated, CT +/- myelography may be an alternative
References
References
Date of literature search: March 2018
The search methodology is available on request. Email
References are graded from Level I to V according to the Oxford Centre for Evidence-Based Medicine, Levels of Evidence. Download the document
- Patel ND, Broderick DF, Burns J, Deshmukh TK, Fries IB, Harvey HB, et al. ACR appropriateness criteria low back pain. J Am Coll Radiol. 2016;13(9):1069-78. (Guideline). View the reference
- Todd NV. Guidelines for cauda equina syndrome. Red flags and white flags. Systematic review and implications for triage. Br J Neurosurg. 2017;31(3):336-9. (Review article). View the reference
- Ropper AE, Ropper AH. Acute spinal cord compression. N Engl J Med. 2017;376(14):1358-69. (Review article). View the reference
- Schiff D. Spinal cord compression. Neurol Clin. 2003;21(1):67-86, viii. (Review article). View the reference
- Yanez ML, Miller JJ, Batchelor TT. Diagnosis and treatment of epidural metastases. Cancer. 2017;123(7):1106-14. (Review article). View the reference
- Moulopoulos LA, Kumar AJ, Leeds NE. A second look at unenhanced spinal magnetic resonance imaging of malignant leptomeningeal disease. Clin Imaging. 1997;21(4):252-9. (Level III Evidence). View the reference
- Cook AM, Lau TN, Tomlinson MJ, Vaidya M, Wakeley CJ, Goddard P. Magnetic resonance imaging of the whole spine in suspected malignant spinal cord compression: impact on management. Clin Oncol (R Coll Radiol). 1998;10(1):39-43. (Level II evidence). View the reference
- van der Sande JJ, Kröger R, Boogerd W. Multiple spinal epidural metastases; an unexpectedly frequent finding. Journal of Neurology, Neurosurgery, and Psychiatry. 1990;53(11):1001-3. (Level II-III evidence). View the reference
- Husband DJ, Grant KA, Romaniuk CS. MRI in the diagnosis and treatment of suspected malignant spinal cord compression. Br J Radiol. 2001;74(877):15-23. (Level II Evidence) View the reference
- Cook AM, Lau TN, Tomlinson MJ, Vaidya M, Wakeley CJ, Goddard P. Magnetic resonance imaging of the whole spine in suspected malignant spinal cord compression: impact on management. Clin Oncol (R Coll Radiol). 1998;10(1):39-43. (Level IV Evidence). View the reference
- Heldmann U, Myschetzky PS, Thomsen HS. Frequency of unexpected multifocal metastasis in patients with acute spinal cord compression. Evaluation by low-field MR imaging in cancer patients. Acta Radiol. 1997;38(3):372-5. (Level III Evidence). View the reference
- Peacock JG, Timpone VM. Doing more with less: diagnostic accuracy of CT in suspected cauda equina syndrome. AJNR Am J Neuroradiol. 2017;38(2):391-7. (Level II-III evidence). View the reference
- Crocker M, Anthantharanjit R, Jones TL, Shoeb M, Joshi Y, Papadopoulos MC, et al. An extended role for CT in the emergency diagnosis of malignant spinal cord compression. Clin Radiol. 2011;66(10):922-7. (Level III Evidence) View the reference
- Klein MA. Lumbar spine evaluation: accuracy on abdominal CT. Br J Radiol. 2017;90(1079):20170313. (Level II-III evidence). View the reference
- van Rijn RM, Wassenaar M, Verhagen AP, Ostelo RWJG, Ginai AZ, de Boer MR, et al. Computed tomography for the diagnosis of lumbar spinal pathology in adult patients with low back pain or sciatica: a diagnostic systematic review. Eur Spine J. 2012;21(2):228-39. (Level II evidence). View the reference
- Notohamiprodjo S, Stahl R, Braunagel M, Kazmierczak PM, Thierfelder KM, Treitl KM, et al. Diagnostic accuracy of contemporary multidetector computed tomography (MDCT) for the detection of lumbar disc herniation. Eur Radiol. 2017;27(8):3443-51. (Level II evidence). View the reference
- Shafaie FF, Wippold FJ, 2nd, Gado M, Pilgram TK, Riew KD. Comparison of computed tomography myelography and magnetic resonance imaging in the evaluation of cervical spondylotic myelopathy and radiculopathy. Spine (Phila Pa 1976). 1999;24(17):1781-5. (Level IV Evidence). View the reference
Information for Consumers
Information for Consumers
Information from this website |
Information from the Royal Australian and New Zealand College of Radiologists’ website |
Consent to Procedure or Treatment Radiation Risks of X-rays and Scans Magnetic Resonance Imaging (MRI) |
Contrast Medium (Gadolinium versus Iodine) Iodine-Containing Contrast Medium Magnetic Resonance Imaging (MRI) Radiation Risk of Medical Imaging During Pregnancy Radiation Risk of Medical Imaging for Adults and Children |
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