A systematic review of the spectrum of magnetic resonance imaging features of degenerative thoracic myelopathy
- 1School of Clinical Medicine, University of Cambridge, Cambridge, UK
- 2Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
Abstract
Purpose. Degenerative thoracic myelopathy (DTM) encompasses a range of degenerative pathologies associated with symptomatic spinal cord compression. Diagnosis is achieved through clinical history, examination, and magnetic resonance imaging (MRI). A comprehensive review of the MRI features of DTM and their clinical significance is currently lacking. The objective was therefore to synthesise current evidence. Methods. A systematic review was performed adhering to PRISMA guidelines. MEDLINE and Embase were searched. Screening, data extraction and risk of bias assessments were performed in duplicate. A qualitative synthesis was conducted following the Synthesis Without Meta-Analysis (SWiM) guidelines. Results. Of 7937 records, 59 papers studying 2940 patients satisfied inclusion criteria, including one cross-sectional and 58 cohort studies. DTM was most common in the lower thoracic spine (62.5%, 880/1409), with a roughly equal prevalence in the upper (18.2%, 256/1409) and middle regions (19.4%, 273/1409). Ossification of the ligamentum flavum (OLF) was the most common pathology (71.4%, 2065/2893), followed by intervertebral disc herniation (20.1%, 582/2893) and ossification of the posterior longitudinal ligament (OPLL) (19.7%, 569/2893). Measurements of spinal canal compromise were described in 55.5% of patients (1631/2940) and spinal cord signal change in 30.0% (881/2940). Spinal canal compromise, spinal cord signal change, OLF, OPLL and multilevel disease were associated with greater DTM severity and poorer functional recovery. Conclusion. Ligamentous pathologies are significantly more prevalent than disc related pathologies in the DTM literature. Spinal cord signal change and extent of spinal canal compromise correlate with clinical outcomes. Standardisation of terminology for imaging features and study design are required to improve future research.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s10143-026-04535-z.
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BibTeX
@article{white2026systematic,
title = {{A systematic review of the spectrum of magnetic resonance imaging features of degenerative thoracic myelopathy}},
author = {Eleanor White and Amir Rafati Fard and Jay Wardropper and Renuka Chintapalli and Edwin Koubeh and Hariesha Pathmaraj and Sruthi Ranganathan and Tanzil Rujeedawa and Chandan Singh Sekhon and Jibin J. Francis and Benjamin M. Davies and Mark R. Kotter and Oliver D. Mowforth},
journal = {Neurosurgical Review},
year = {2026},
month = oct,
doi = {10.1007/s10143-026-04535-z},
url = {https://doi.org/10.1007/s10143-026-04535-z},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - A systematic review of the spectrum of magnetic resonance imaging features of degenerative thoracic myelopathy
AU - Eleanor White
AU - Amir Rafati Fard
AU - Jay Wardropper
AU - Renuka Chintapalli
AU - Edwin Koubeh
AU - Hariesha Pathmaraj
AU - Sruthi Ranganathan
AU - Tanzil Rujeedawa
AU - Chandan Singh Sekhon
AU - Jibin J. Francis
AU - Benjamin M. Davies
AU - Mark R. Kotter
AU - Oliver D. Mowforth
PY - 2026
DA - 2026/10/26
JO - Neurosurgical Review
DO - 10.1007/s10143-026-04535-z
UR - https://doi.org/10.1007/s10143-026-04535-z
AB - Purpose. Degenerative thoracic myelopathy (DTM) encompasses a range of degenerative pathologies associated with symptomatic spinal cord compression. Diagnosis is achieved through clinical history, examination, and magnetic resonance imaging (MRI). A comprehensive review of the MRI features of DTM and their clinical significance is currently lacking. The objective was therefore to synthesise current evidence. Methods. A systematic review was performed adhering to PRISMA guidelines. MEDLINE and Embase were searched. Screening, data extraction and risk of bias assessments were performed in duplicate. A qualitative synthesis was conducted following the Synthesis Without Meta-Analysis (SWiM) guidelines. Results. Of 7937 records, 59 papers studying 2940 patients satisfied inclusion criteria, including one cross-sectional and 58 cohort studies. DTM was most common in the lower thoracic spine (62.5%, 880/1409), with a roughly equal prevalence in the upper (18.2%, 256/1409) and middle regions (19.4%, 273/1409). Ossification of the ligamentum flavum (OLF) was the most common pathology (71.4%, 2065/2893), followed by intervertebral disc herniation (20.1%, 582/2893) and ossification of the posterior longitudinal ligament (OPLL) (19.7%, 569/2893). Measurements of spinal canal compromise were described in 55.5% of patients (1631/2940) and spinal cord signal change in 30.0% (881/2940). Spinal canal compromise, spinal cord signal change, OLF, OPLL and multilevel disease were associated with greater DTM severity and poorer functional recovery. Conclusion. Ligamentous pathologies are significantly more prevalent than disc related pathologies in the DTM literature. Spinal cord signal change and extent of spinal canal compromise correlate with clinical outcomes. Standardisation of terminology for imaging features and study design are required to improve future research. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s10143-026-04535-z.
SN - 0344-5607
SN - 1437-2320
ER -