Describe the typical radiographic and imaging findings associated with cervical spondylotic myelopathy

A variety of spinal pathologies may result in cord compression and lead to subsequent development of myelopathy. Spinal pathology may occur at a single level or, more commonly, involve multiple spinal levels. Patterns of cord encroachment vary and include anterior-based compression, posterior-based compression, or circumferential compression. Many patients with myelopathy have a congenitally small spinal canal with a mid-sagittal diameter measuring less than 10 mm. Associated imaging findings may include anterior and posterior osteophytes, retrolisthesis (especially at C5-C6 and C6-C7), anterolisthesis (most common at C3-C4 and C4-C5), and acute soft tissue disc herniation. MRI may demonstrate focal or diffuse cord compression. Plastic deformation of the cord with decreased anteroposterior diameter and increased medial-lateral diameter may be noted. In 20% to 40% of cases, signal changes in the cord are present on MRI. If high signal is present only on T2-weighted images, this represents a broad range of pathology (e.g. edema) and may be reversible. It does not necessarily indicate a poor potential for recovery following surgery. If high signal is present on T2-weighted images and low signal is present on Tl-weighted, this represents a severe gray matter lesion with a poor prognosis.

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