Spinal cord dysfunction is a common neurological problem, which may have an obvious traumatic or compressive cause. Beyond this, the lack of pathological specificity of the clinical and imaging features means that patients are often treated empirically, based on the prevalence and the treatability of the differential diagnoses; multiple sclerosis (MS) and isolated inflammatory myelitis are the most likely diagnoses in the western world [1].

Myelopathy describes any neurologic deficit related to the spinal cord. Myelopathy is usually due to compression of the spinal cord by osteophyte or extruded disc material in the cervical spine. Osteophytic spurring and disc herniation may also produce myelopathy localised to the thoracic spine, though less commonly [2]. Myelopathy, the rapid or insidious onset of motor and sensory abnormalities referable to the spinal cord, occurs as a result of a variety of causes that may be classified on the basis of their location of origin (intramedullary, intradural-extramedullary, and extradural) [3].

Degenerative cervical myelopathy (DCM) is a progressive spine disease and the most common cause of spinal cord dysfunction in adults worldwide [4]. With the aging of the global population, clinicians will be required to manage an increasing number of patients with degenerative changes to their spine and varying stages of myelopathy [5]. Cervical spondylotic myelopathy is the result of the narrowing of the cervical spinal canal by degenerative and congenital changes [6]. Cervical spondylotic myelopathy (CSM) is the leading cause of myelopathy in subjects above 55 years old and the major cause of spasticity acquired in the aged population [7].

Although a survey of the entire spinal cord can be performed with imaging, it is more appropriate to define from the clinical findings what levels of the spine and spinal cord should be imaged. This approach helps limit the likelihood of false-positive imaging findings that may encourage needless attempts to fix what is not broken [8]. For most patients presenting with a spinal cord syndrome, MR scanning has become the key investigation in establishing the diagnosis. However, myelopathy with normal spinal imaging remains a common clinical conundrum [9]. Hence a

expressed as frequencies and percentages for categorical variables. IBM SPSS version 22 was used for statistical analysis [10].

In the present series, the patient’s age ranged from 20 years to 80 years. The maximum incidence is in the third to sixth decade constituting 72% of cases. The majority of 53.33% of participants were aged between 51 to 60 years, followed by 61 to 70 years was 13.33%, 21 to 30 years and 41 to 50 was 10% for each. In the present series, 28 (93%) participants were male and 2 (7%) participants were female (Table 1).

Clinical Features: Clinical features of spinal cord compression vary depending upon the sources of compression and the tracts involved in the spinal cord. The incidence of various symptoms and signs are shown in the following table. The highest number is with weakness of all 4 limbs. The majority of 97% of participants had difficulty in walking, followed by tingling and numbness, pain weakness of upper and lower limbs, and loss of muscle mass was 87%, 83%, 70%, and 47% respectively. ONSET: The onset in the present series varied from a few hours to 2 years. Onset varied with the site of involvement and the nature of etiology onset was rapid whenever there is associated factor-like trauma. The onset was acute in 30 % of cases. Motor Power: Grading of motor power was done according to the medical research council. In the present series grade ‘0’ power was present in four cases grade 1-2 in four cases, grade 3 power in five cases, grade 4 power in sixteen cases, grade 5 in one case. (Table 2)

Table-1: Distribution of cases according to age and sex.

Table-2: Distribution of cases according to signs, symptoms, onset and motor power.

central cord was 20%, 13.33%, and 10% respectively (Figure 1).

Imaging findings of the study participants: In the case of cervical spondylosis, there was a decrease in the height of the vertebral body. There is bulging of the intervertebral disc causing indentation of theca of the cord. Dehydration of intervertebral discs is noted. The bulging of the disc material on the spinal cord has produced myelomalacia in some cases. The thickening of the posterior longitudinal ligament is seen in some cases.

In our series, six cases of dorsal vertebrae and four cases of lumbar vertebrae were involved. Involvement of bodies, disc space, posterior elements causing loss of height of vertebrae with severe cord compression with edema was noted. These were seen as hypointensity with T1W and hyperintensity with T2W images as observed in vertebrae due to destruction. Two cases of Endemic Fluorosis were noted in the present study forming 7%. Radiologically both cases showed straightening of C-spine with degenerative endplate changes, thickening of posterior longitudinal ligament particularly between C2-C6 levels in one case, there was the narrowing of spinal cord dimensions compromising at C3-C4 level causing cord compressions with myelomalacia changes in the second case. One case of neurofibroma presenting as an extradural mass in T2 weighted images impinging spinal cord and extension into the neural foramina without any destruction of bone.

Myelopathy is a broad term that refers to spinal cord involvement of multiple etiologies. Spinal cord diseases often have devastating consequences, ranging from quadriplegia and paraplegia to severe sensory deficits due to its confinement in a very small area.

Many of these diseases are potentially reversible if they are recognized on time, hence the importance of recognizing the significance of magnetic resonance imaging when approaching a multifactorial disease considered as one of the most critical neurological emergencies, where prognosis depends on an early and accurate diagnosis [11].

Narrowing (stenosis) of the spinal canal may result in myelopathy anywhere along the spinal axis, where the spinal cord is present. A common cause of acquired stenosis resulting in myelopathy is

67.7%, scissoring gait in 32.2%, diaphragmatic weakness in 12.9% of patients. Myelopathy may result in little or no dysfunction—or severe dysfunction with gait disturbances [20]. Results of the study by Nishimura, H et al[21], suggested that when the percentage of the stance phase in the gait cycle increased to above 70%, the CSM patients had an increased fall risk. A case report and review of the literature reported that the patient developed cervical radiculopathy, followed by gait disturbance and motor weakness [22].

Cervical motion segment disorders are considered to be multifactorial, and the developmental size of the canal and foramina, pathological encroachment, biomechanical effects, and circulatory deficiencies are always present to some degree. Static and dynamic factors should be considered for the development of myelopathy. To clarify the pathomechanism of the development of myelopathy in patients with cervical spondylotic spinal cord compression, the exact natural history of CSM should be understood [23].

Cervical spondylotic myelopathy (CSM) is the leading cause of myelopathy in subjects above 55 years old and the major cause of spasticity acquired in the aged population. More than 50% of middle-aged people have radiographic evidence of cervical alteration, yet only 10% have symptoms of spinal cord compression or cervical radiculopathy [6,7,24]. In the present study cervical spondylosis was common according to etiology.

Similar results were found by the investigators of the study conducted in Bangladesh where investigators found among etiologies that cervical spondylotic myelopathy (31%) was most commonly diagnosed [25]. The cervical myelopathy syndrome was first described in 1952, in some cases performed by Brain and colleagues [26]. In an extensive literature search, it was concluded that the prevalence of surgically treated cervical spondylotic myelopathy was estimated as 1.6 per 100,000 inhabitants [27].

Faysal MM et al [17]. Cervical spondylotic myelopathy and transverse myelopathy was the main etiology of compressive and non-compressive myelopathy respectively. The current study revealed that the cervical cord was more commonly involved. Similarly, Erdal, Y et al [28], found that common involvement of Cervical cord compared to other regions of the cord. It was found that only 2 participants presented with fluorosis. Gupta, RK et

The present study results have analyzed the profile of myelopathies and found more male preponderance. The commonest cause of compressive myelopathy was Cervical spondylosis. Anterior plus posterior cord syndrome was the commonest pattern seen which was followed by posterior cord syndrome and the least observed pattern was anterior cord syndrome. Hence, it can be concluded that MRI could suggest the location of the lesion and correlated well with clinical diagnosis. Magnetic resonance imaging was found to be highly useful in the evaluation of compressive lesions of the spinal cord.

Myelopathies are rare but severe disabling neurological illness. Cervical spondylosis is the most common cause. The etiology can be varied.

Dr. Jakkula Sri Kiran had conceptualized the study, prepared the study protocol, conducted the data collection, analysis, and manuscript writing. He has verified all the drafts and approved the final draft. Dr. Shaik Afsar Pasha and Dr. M Nageswara Rao had provided key inputs on methodology during protocol preparation, supported data compilation, and analysis. He has also edited all the drafts and approved the final draft of the manuscript.

Authors acknowledge the technical support in data entry, analysis and manuscript editing by “Evidencian Research Associates.”