Pathology of DCM. (A) Anatomy of an initially healthy spine (C2 level), with examples of the potential pathological changes that can occur and cause DCM.

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Pathology of DCM. (A) Anatomy of an initially healthy spine (C2 level), with examples of the potential pathological changes that can occur and cause DCM (shown at lower spinal levels; C3-7).1 (B) Sagittal section from a T2-weighted MRI scan showing multilevel degenerative changes in the cervical spine. Pathology of DCM. (A) Anatomy of an initially healthy spine (C2 level), with examples of the potential pathological changes that can occur and cause DCM (shown at lower spinal levels; C3-7).1 (B) Sagittal section from a T2-weighted MRI scan showing multilevel degenerative changes in the cervical spine. The spinal cord is compressed at C3/4 by a disc prolapse (white arrow) and at C5/6 by spondylosis, thickening of the posterior longitudinal ligament, and a disc-osteophyte complex (white star). However, this is not associated with high signal changes in the cord on MRI (Figure reproduced with permission from Michael G Fehlings, University of Toronto)3 Benjamin M Davies et al. BMJ 2018;360:bmj.k186 ©2018 by British Medical Journal Publishing Group