An accurate history and physical examination is essential in diagnosing spinal cord compression. The neurologic examination often identifies the suspicious areas allowing for improved accuracy in imaging the appropriate affected areas of the spine. Patients with spinal cord compression often have abnormalities on plain radiographs of the spine. The abnormalities encountered may include bony erosion and pedicle loss, partial or complete vertebral collapse, and paraspinous soft tissue masses. However, normal spine films do not exclude epidural metastasis.
MR tomography of the spine is the best method for evaluating epidural spinal cord compression. Gadolinium enhancement may be utilized when there is suspicion of cord compression due to epidural abscess. Gadolinium will enhance inflamed tissues and will define anatomic margins. Myelography requires an experienced physician and accompanied by CT may be performed with minimum patient discomfort. However, when metastatic disease completely blocks the spinal cord, myelography will not allow definition of the upper margin of tumor involvement.