30th December 2024

Investigation of MSCC

The gold standard investigation is an MRI of the whole spine, which should be performed within 24 hours of presentation. Even where there are localising signs, the whole spine should be imaged as there may be other sites of cord compression (or impending compression) above or below the symptomatic lesion.

In 15-20% of cases there may be no abnormalities on a plain X-ray, and this should not be used to rule out MSCC.

In addition, CT imaging of the spine may be considered, to guide decisions on bony stability and surgical options.

In cases where MRI is contraindicated or unavailable, CT may be considered with or without concurrent myelography. This should be performed only in specialist centres, as myelography may cause neurological deterioration, requiring urgent decompression.