A Caution about the Use of MRI to Diagnose Spinal Cord Compression

Abstract

Spinal cord impingement by metastatic carcinoma is a medical emergency. After this condition has been diagnosed, urgent therapeutic intervention (either radiotherapy or decompressive surgery) must be instituted to prevent the inevitable progression of neurologic dysfunction.¹ Traditionally, myelography has been essential for the diagnosis of this disease.² Often the patient's clinical presentation and plain roentgenograms of the spine suggest the area of impingement, but a myelogram allows verification of the site. Also, myelography (with injections from above and below the blocked area) allows adequate visualization of the remaining spinal cord in order to determine whether there are multiple areas of impingement. Therefore, therapy can be directed to all areas of spinal cord impingement.