T2-Weighted Whole Spine Sagittal MRI for the Identification of Cervical Cord Compression in Degenerative Spinal Conditions: A Systematic Review

Study 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.

Cervical cord compression (CCC) is a critical radiologic finding arising from degenerative, congenital, traumatic, neoplastic, and/or inflammatory aetiologies.1 While degenerative cervical stenosis and CCC are incidentally detected in up to 24.2% of asymptomatic adults based on population-based studies, CCC is a well-established predictor for the development and progression of degenerative cervical myelopathy (DCM).2

Early identification of CCC, particularly its symptomatic form, DCM, is crucial given its association with progressive and often irreversible neurological sequelae.1,2 Both CCC and DCM have been identified when screened for in several at-risk groups, most commonly in patients presenting for evaluation of degenerative spinal complaints, such as lumbar spinal stenosis (LSS).3,4 Notably, up to 60% of patients with symptomatic LSS exhibit concomitant radiologic CCC, a phenomenon described as tandem spinal stenosis.3 While not always symptomatic, identification of tandem CCC in the preoperative setting in patients undergoing thoracolumbar and complex adult deformity surgery may have implications for surgical staging, approach,5 intraoperative anesthetic positioning,6 and differential diagnostic considerations for patients with nonconcordant neurological symptoms.7

Typically, the assessment of tandem CCC would require further dedicated regional imaging of the cervical spine. T2-weighted whole spine sagittal magnetic resonance imaging (WSSMRI) (Figure 1B) sequences may present an opportunity to identify tandem CCC without dedicated regional MRI. WSSMRI sequences are often incorporated into thoracic and lumbar spine MRI protocols for vertebral segmentation and screening for incidental pathology.8 Although inherently limited by the absence of axial sequences and contingent on sufficient image acquisition parameters, T2-weighted WSSMRI sequences may provide an opportunistic visualization of CCC in patients undergoing radiological/surgical evaluation for thoracic and lumbar spinal pathology