Musculoskeletal causes of spinal axis compromise: beyond the usual suspects

The majority of cases of spinal canal compromise are caused by common pathologic conditions, including degenerative spondylosis, infection, trauma, and metastatic disease. However, there are other causes of spinal canal compromise that, though unusual, may be seen in everyday practice. Congenital abnormalities of the spine that may produce spinal canal compromise include the os odontoideum, hemivertebra, diastematomyelia, and achondroplasia. Arthritides and enthesopathies such as rheumatoid arthritis, ankylosing spondylitis, synovial cysts of the facet joint, calcium pyrophosphate dihydrate deposition or hydroxyapatite deposition, and ossification of the posterior longitudinal ligament or ligamentum flavum may lead to narrowing of the spinal canal. Primary spinal tumors and tumorlike lesions such as hemangioma, aneurysmal bone cysts, osteochondroma, and osteoblastoma may also cause spinal canal stenosis. Finally, Paget disease of bone may compromise the spinal cord. Radiologists should be aware of these unusual musculoskeletal causes of spinal canal compromise and their radiologic and clinical features.