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So we are only about 15 minutes into this session

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and I've already lied to you twice.

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Here are the two lies.

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Number one is I said that the most common lesions

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of the spinal cord are going to be demyelinating

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neoplastic and congenital. Actually,

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the most common lesion of the spinal cord

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is this and that is spondylomyelopathy.

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Here you see an area of abnormality in the spinal

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cord that is seen on the T2-weighted scan,

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as well as the STIR image.

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Let me just highlight that.

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This is at the C4 level.

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And you see that there is adjacent degenerative

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change at C3-C4, C4-C5 and C5-C6.

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So that's my first lie.

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My second lie was in telling you that when

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you have a lesion of the spinal cord,

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it causes narrowing of the CSF space

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at the site of the spinal cord lesion.

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That's true for mass lesions.

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However, when you have cord atrophy,

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you actually see dilatation of the CSF space at

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the level of the atrophic spinal cord.

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On the axial plane,

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as we scroll,

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we can see the central cord signal abnormality

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on the gradient echo scan and to the left of

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midline on the fast spin echo sequence

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where the cord has been damaged.

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It's actually been damaged bilaterally,

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left worse than right.

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And this central cord involvement is not uncommon

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in patients who have spondylomyelopathy.

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So this is the most common cord lesion,

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intradural intramedullary lesion,

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secondary to degenerative change.

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And that might be from disc herniations,

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or osteophytes, or posteriorly from degenerative facet

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joint disease or ligamentum flavum thickening.

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So again, T1-weighted scan,

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fast spin echo T2-weighted scan, and gradient echo scan.

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These are the pulse sequences that are typically

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used in cervical spine imaging.