Imaging of the Spinal Cord: Classic Syndromes and Non-neoplastic Lesions

The goal of this review was to provide an approach for localizing and characterizing focal non-neoplastic lesions of the spinal cord. There are 8 classic syndromes associated with disorders of the spinal cord and cauda equina. These syndromes are defined by characteristic sensory impairment, motor weakness, abnormal reflexes, altered muscle tone, and related organ dysfunction. Most pathology of the spinal cord, however, does not present as a recognizable syndrome, and the imaging appearances of many focal non-neoplastic lesions are similar. The goal of this review was to describe the typical clinical presentations and physical examination findings of classic spinal cord syndromes. We described imaging features of many disorders that present with these classic clinical syndromes. We also described the characteristic imaging features used to distinguish between several non-neoplastic spinal cord lesions that do not fall into a single spinal cord syndrome category. We divided these into 3 groups: lesions with cord atrophy, lesions with ring enhancement, and lesions with important ancillary findings.

Learning Objectives: To recognize common pathology that results in classic spinal cord syndromes and describe MR imaging findings that may distinguish among non-neoplastic lesions of the spinal cord.