A systematic review of the spectrum of magnetic resonance imaging features of degenerative thoracic myelopathy.
Eleanor White, Amir Rafati Fard, Jay Wardropper et al.
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In 30 seconds
This PRISMA-guided systematic review synthesised evidence on MRI features of degenerative thoracic myelopathy (DTM) and their clinical significance. It included 59 studies of 2,940 patients: one cross-sectional study and 58 cohort studies, with qualitative synthesis. Ossification of the ligamentum flavum was the most frequently reported pathology (71.4%, 2065/2893), compared with intervertebral disc herniation (20.1%, 582/2893) and ossification of the posterior longitudinal ligament (19.7%, 569/2893). Spinal canal compromise, cord signal change, ligamentous ossification and multilevel disease were associated with greater severity and poorer functional recovery.
Key findings
- DTM was most common in the lower thoracic spine (62.5%, 880/1409).
- Ossification of the ligamentum flavum was reported in 71.4% (2065/2893), more often than disc herniation (20.1%, 582/2893).
- Spinal canal compromise was described in 55.5% (1631/2940) of patients and spinal cord signal change in 30.0% (881/2940).
- Canal compromise, cord signal change, OLF, OPLL and multilevel disease were associated with greater severity and poorer functional recovery.
Why it matters
The review brings together MRI findings across a broad DTM literature and highlights that ligamentous pathology is more prevalent than disc-related disease in the included studies. It also identifies imaging features associated with severity and recovery, helping frame MRI interpretation in relation to clinical outcomes. Variation in terminology and study design limits comparisons and points to a need for more consistent reporting.
What to keep in mind
The evidence was predominantly observational: 58 of 59 included studies were cohort studies. The review used qualitative synthesis, and the authors call for standardised imaging terminology and study design.