MRI as Essential Diagnostic and Prognostic Tool in C5‑C6 Spinal Cord Compression Without Myelopathy

Diagnostic Superiority of MRI

In patients with C5‑C6 spinal cord compression but no clinical myelopathy, an immediate cervical MRI is recommended to assess intramedullary signal changes, quantify the degree of cord compression, and guide definitive management decisions. 1
MRI provides superior visualization of the spinal cord parenchyma compared with CT, allowing detection of early cord injury (e.g., T2‑weighted hyperintensity), precise evaluation of compression severity, and exclusion of alternative pathologies. [1][3]
Computed tomography is limited to bony anatomy and cannot adequately assess the spinal cord itself, making it insufficient as a sole imaging modality for this scenario. [3][4]

Presence of intramedullary T2 hyperintensity on MRI indicates cord injury and is associated with worse postoperative outcomes if surgical decompression is delayed, thereby influencing the urgency of surgical referral. 1
MRI findings are prognostic overall and directly shape surgical decision‑making in patients with cervical cord compression, even when overt myelopathy is absent. 1

Management algorithms for C5‑C6 compression without myelopathy must incorporate MRI findings; reliance on CT alone is discouraged because MRI is mandatory for accurate assessment and risk stratification. [1][3]