Spinal Cord Compression and tumors

What are the available imaging procedures for evaluation of spinal cord compression and their utility?

• Sagittal MRI images of the entire spinal cord should be done so other subclinical lesions are not missed.
• MRI is the best imaging technique to evaluate patients with spinal cord compression.
• CT myelography is an alternative if MRI cannot be done, but requires lumbar puncture and instillation of contrast.

Case 1:

A 73 y/o male with a history of kidney cancer presents to the ER with weakness of his lower extremities, and incontinence early today. He also complains of severe lower back pain. On exam, the patient is found to have increased deep tendon reflexes and spastic paralysis, of both lower limbs, with absent pinprick and temperature sensation in the lower limbs up to the umbilicus.

Which imaging procedure will you order?

Emergency MRI of spine

What is your clinical diagnosis?

Spinal cord compression from metastatic disease.

Pre-contrast sagittal T1 wtd.MRI of the thoracic spine Low signal (dark) Mass on T1	Sagittal T2 wtd. MRI Mass is bright on T2 and shows compression of cord (black) Surrounded by CSF (bright)	Post contrast sagittal T 1 wtd. MRI Post contrast shows enhancement of mass	Pre contrast axial T 1 wtd. MRI Non-contrast T1 axial scan shows compression of cord by mass
Bony metastasis from renal cell carcinoma with epidural tumor producing cord compression Findings: Bony metastasis involving the T 8 vertebral body, right pedicle/transverse process and spinous process (arrow in A,B,C,D) with epidural tumor producing marked degree of cord compression (red arrow).

Case 2:

A 68 year old male presents with shooting pain along the back of right leg. He has been having back ache for the past 6 months. His sensation and strength are intact but the right ankle reflex is absent.

Which imaging procedure will you order?

MRI of lumbar spine

What is your clinical diagnosis?

R S1 radiculopathy from degenerative arthritis or herniated disc.

Osteoarthritis Herniated Disc