Imaging Biomarkers for Compressed Spinal Cord: Unlocking the Silent Injury in Early Myelopathy

Degenerative cervical myelopathy is a leading cause of spinal cord dysfunction, yet early diagnosis remains elusive. We review the evolution of imaging biomarkers for the compressed spinal cord, from subjective qualitative assessment to reproducible quantitative analysis. Drawing on lessons from multiple sclerosis research, we discuss how magnetization transfer imaging and diffusion tensor imaging detect microstructural injury, including myelin loss and axonal damage, in tissues appearing normal on conventional MRI. We describe advances in radiomics and machine learning that enable high-dimensional texture and shape analysis for objective functional assessment. These techniques enable reliable cross-site implementation.