T2-Weighted Whole Spine Sagittal MRI for the Identification of Cervical Cord Compression in Degenerative Spinal Conditions: A Systematic Review
Rohil V. Chauhan, Anand H. Segar, Ciaran Regan, David Rice, Steven G. WhiteStudy Design:
PRISMA-compliant systematic review.
Objective:
This review aimed to evaluate the clinical prevalence and significance of cervical cord compression (CCC) identified on T2-weighted whole spine sagittal MRI (WSSMRI) sequences.
Summary of Background Data:
WSSMRI sequences are frequently acquired alongside thoracolumbar MRI for vertebral segmentation, but may also detect previously unrecognized CCC, a key risk factor for degenerative cervical myelopathy. The clinical significance of WSSMRI-identified CCC remains unclear.
Materials and Methods:
Five databases were searched for studies evaluating CCC on T2-weighted WSSMRI in adults undergoing MRI for degenerative spinal conditions from inception to September 2026. Two reviewers independently performed study selection and data extraction. Data were synthesized descriptively, with subgroup analyses by age (60 y or older) and symptomatic lumbar spinal stenosis (LSS).
Results:
The search yielded 552 articles, of which 48 full texts were reviewed, and six studies were included for analysis. All six studies were retrospective observational cohorts from tertiary orthopedic/neurosurgical settings. Across the six included studies, 2634 participants were included (mean age=56.9), of whom 375 had WSSMRI-identified CCC (aggregate prevalence: 14.2%; range: 5.4%–53%). The aggregate prevalence among patients aged 60 years or older and among patients with symptomatic LSS was 28.3% (range: 23.7%–53%) and 23.9% (23.7%–23.9%), respectively. Three studies provided detail regarding symptomatic CCC, whereby 47 out of 147 CCC cases exhibited myelopathic symptoms (32.0%). Overall, studies had a low to moderate risk of bias (5–7/7) and were of moderate quality (4–7/9).
Conclusion:
T2-weighted WSSMRI may serve as an adjunctive and opportunistic imaging sequence for identifying CCC. While a more quantitative prevalence estimate was not appropriate due to heterogeneous image evaluation methods, CCC was frequently identified in older adults and those with lumbar spinal stenosis, where tandem spinal pathology is common. Further studies are needed to assess its comparative performance and accuracy compared with cervical spine MRI.