neurologic disorders
Spinal Cord Compression
Diagnosis of Spinal Cord Compression
MRI or CT myelography Spinal cord compression is suggested by spinal or radicular pain with reflex, motor, or sensory deficits, particularly at a segmental level. If patients have sudden spinal or radicular pain with reflex, motor, or sensory deficits, particularly at a segmental level, image the spinal cord and treat the cause immediately. MRI is done immediately if available. If MRI is unavailable, CT myelography is done; a small amount ofiohexol(a nonionic, low osmolar radiopaque agent) is introduced via a lumbar puncture and allowed to run cranially to check for complete block of the cerebrospinal fluid (CSF). If a block is detected, a radiopaque agent is introduced via a cervical puncture to determine the rostral extension of the block. If traumatic bone abnormalities (eg, fracture, dislocation, subluxation) that require immediate spinal immobilization are suspected, plain spinal x-rays can be done. However, CT detects bone abnormalities better. 