This review is based on a comprehensive analysis of the literature and clinical experience in the evaluation of traumatic and nontraumatic spinal cord compression. We included 40 patients with low back ache , with a focus on MRI findings in acute myelopathy. Key imaging sequences, including T1-weighted, T2-weighted, short tau inversion recovery (STIR), and contrast-enhanced MRI, were evaluated to identify characteristic features of compressive and noncompressive myelopathy.

The compartmental approach to spinal MRI interpretation was emphasized, with lesions categorized based on their location within the epidural, intradural extramedullary, or intramedullary spaces. This approach was combined with clinical and laboratory findings to refine the differential diagnosis and guide management decisions. The authors also reviewed case studies and imaging examples to illustrate typical and atypical presentations of various spinal cord pathologies.

The following sections provide a detailed discussion of the MRI findings and differential diagnoses for compressive and noncompressive myelopathy, organized by anatomical compartment and underlying etiology.