MRI Cervical Spine — degenerative and myelopathy
Craniocervical junction to at least T2/T3, so that the cervicothoracic junction is included.
Typical, not policy
Timings, volumes and delays here are representative values drawn from published guidance. Scanner generation, injector, cardiac output and local preference all move them. Confirm against your department's own protocol before you rely on a number.
When to use it
- Cervical radiculopathy that has failed conservative management or has a motor deficit.
- Suspected cervical myelopathy with gait disturbance, hand clumsiness or upper motor neurone signs.
- Neck trauma with a neurological deficit or with an abnormality on CT requiring ligamentous and cord assessment.
- Pre-operative planning for anterior or posterior cervical decompression.
- Suspected cervical cord lesion where compression must be excluded before an inflammatory work-up.
Technique
- Sagittal T1, sagittal T2 and axial T2 are the core; axial gradient-echo is used in some centres for better osteophyte-versus-disc discrimination, at the cost of exaggerating canal narrowing.
- A sagittal fluid-sensitive fat-suppressed sequence is added where trauma, infection or malignancy is possible.
- Axial coverage should span every level with sagittal cord deformity, not just the worst one.
- Thin sections are needed for the foramina; cervical foraminal stenosis is under-called on thick axials.
Where it goes wrong
- Coverage stopping at C7 and missing cervicothoracic junction pathology.
- Gradient-echo axials over-representing bony canal narrowing because of susceptibility blooming.
- Swallowing and vascular pulsation artefact projecting through the cord on sagittal T2.
- Anterior cervical plate artefact obscuring the operated level, which is often the level in question.
- Attributing myelopathic signal change without axial correlation.
Clinical questions that reach this study
Contrast
None
- Unenhanced for degenerative disease and myelopathy. Contrast is reserved for infection, tumour and post-operative recurrent disc versus scar.
Acquisition
- Breathing
- Free breathing; swallowing is the main motion problem and patients should be asked to minimise it.
- Preparation
- State the affected dermatome or myotome and whether there are myelopathic signs; the two questions need different axial coverage. Anterior cervical plates and disc replacements should be flagged for device conditionality and artefact expectations.
Safety checks this protocol carries
Derived from the contrast agent and phases above, not authored here — which is why they cannot drift apart from what the protocol actually does.
- MR safety screening for implants and foreign bodies· radiographer at scan