Introduction to Evolving Concepts Related to Spinal Cord Compression

Spinal cord compression has traditionally been understood as a primarily mechanical lesion, yet contemporary evidence reframes it as a dynamic, systems-level disorder. Using degenerative cervical myelopathy as the principal clinical model, this introductory article traces the evolution of pathophysiological understanding from purely geometric paradigms toward an integrated view incorporating ischemia, blood-spinal cord barrier disruption, neuroinflammation, demyelination, and remote tract degeneration. It synthesizes how quantitative MRI, morphometrics, radiomics, and machine learning are reshaping diagnosis and prognostication, and outlines a precision-medicine framework that personalizes timing, risk stratification, and emerging neuroprotective and regenerative therapies.