Myelopathy

. 2008 May;29(5):1032–1034.

Clinical condition: myelopathy

	CT spine without contrast	CT spine with contrast	CT myelography	MRI spine without contrast	MRI spine without and with contrast	X-ray spine	X-ray myelography	CTA spine	MRA spine
Traumatic	9^a	2	5^b	8^c ^d	2	7^e ^f	3^g	3^h	3^h
Painful^*	7ⁱ	3^j	5^k	8	7^l	3^f	2^g	2^c	2
Sudden onset^†	5^k	3	6^k	9	8	3^f	6^g	5^m	4^m
Stepwise progressive^‡	5^k	3	6^k	9	8	3	6^g ^m	5	4
Slowly progressive^§	6ⁱ	3^j	5^k	8	7	3^f	5^g ⁿ	2	2
Infectious disease patient^‖	6^k	5	5^k	8	9	3^f	5^g ^k	2	2
Oncology patient^¶	6^k	4	5^k	9	8	3^o	5^g ^k	2^c	2

Note:—Rating Scale: 1, least appropriate; 9, most appropriate.

^{^a}

First test for acute management.

^{^b}

MRI preferable.

^{^c}

Problem solving or operative planning.

^{^d}

Most useful when injury not explained by bony fracture.

^{^e}

May be first test in multi-symptom trauma, especially when CT is delayed.

^{^f}

To assess stability.

^{^g}

Usually performed in conjunction with CT.

^{^h}

For suspected vascular trauma.

^ⁱ

Most useful for spondylosis.

^{^j}

Consider for infection, neoplasm or if MRI unavailable or contraindicated.

^{^k}

Problem solving or if MRI unavailable or contraindicated.

^{^l}

If infection or neoplastic disorder suspected.

^{^m}

If AVM is suspected.

^ⁿ

If MRI is not possible or for preoperative planning and problem solving.

^{^o}

Assess stability or for treatment planning.

Bone scan, rating of 4 to search for associated extra spinal disease.

^†

Arteriography spine, rating of 4 if AVM suspected.

^‡

Arteriography spine, rating of 6 if AVM suspected.

^§

Bone scan, rating of 4 and arteriography spine, rating of 4.

^‖

WBC scan rating of 4 may be combined with bone scan to diagnose osteomyelitis.

^¶

Bone scan, rating of 6 to search for associated extra spinal disease.