How do I read the two views?
Sagittal: from the side
A side view of the whole neck in one picture: the curve, the seven vertebrae, the discs between them, and the cord running down the canal.
Axial: looking down
A cross-section through one level. The grey oval in the middle is the spinal cord, wrapped in a bright ring of fluid. This is the view that shows what is pressing on what.
Watch the fluid ring
A continuous bright ring around the cord means room to spare. Losing it at one level means the canal is crowded there, and it is the first thing a spine surgeon checks.
Every labeled structure, explained
Sagittal MRI, cervical spine
A side view of the neck, from the base of the skull down to the upper chest.
- Vertebral bodies (C1 to C7)
- The stacked blocks of bone that form the cervical spine, labeled C1 through C7 from top to bottom. From the side you can see their alignment and the gentle forward curve a healthy neck should have. Spinal alignment.
- Intervertebral discs
- The cushions between the neck vertebrae. A bulging or herniated cervical disc can press backward on a nerve root or the cord, causing neck pain that radiates into the shoulder, arm, or hand. Cervical radiculopathy.
- Spinal cord
- The spinal cord runs down the center of the canal as a grey band surrounded by brighter fluid. Narrowing that flattens or dents the cord can cause cervical myelopathy: trouble with the hands, walking, and balance. Cervical myelopathy.
- Spinal fluid (CSF)
- The brighter fluid surrounding the cord. A continuous bright stripe in front of and behind the cord is a reassuring sign that there is healthy space inside the canal. Cervical myelopathy.
- Anterior longitudinal ligament
- A strong ligament (highlighted blue) running down the front of the vertebral bodies. It supports the spine and limits backward bending of the neck.
- Posterior longitudinal ligament
- A ligament (highlighted salmon) along the back of the vertebral bodies, just in front of the cord. It helps contain the discs. When it hardens or turns to bone, a condition called OPLL, it can narrow the canal. OPLL.
- Ligamentum flavum
- A ligament (highlighted yellow) at the back of the spinal canal. With age it can thicken and buckle inward, pinching the cord from behind. It is a common contributor to canal narrowing. Cervical myelopathy.
- Nuchal ligament
- A large ligament (highlighted green) running down the back of the neck from the skull to the spine. It supports the weight of the head and is the firm cord you can feel at the back of your neck.
Axial MRI, cervical spine
A view looking straight down through one slice of the neck.
- Spinal cord
- The spinal cord sits in the center of the canal as a grey oval surrounded by bright fluid. In the neck it carries the signals for your arms, hands, and the rest of your body. Pressure on the cord here can cause neck pain, hand clumsiness, balance trouble, or weakness. Cervical myelopathy.
- Spinal fluid (CSF)
- The bright ring of cerebrospinal fluid that cushions the spinal cord. A healthy ring of fluid all the way around the cord means there is room to spare. Losing that ring is a sign the canal is crowded. Cervical myelopathy.
- Vertebral body
- The block of bone at the front of the spine that bears weight. A disc sits between each pair of bodies. A worn or herniated cervical disc can press backward toward a nerve root or the cord. Cervical radiculopathy.
- Vertebral arteries
- A pair of arteries that travel up through small channels in the sides of the neck vertebrae to supply the brain. Their location is one reason neck surgery calls for precision and careful planning.
- Facet joints
- The paired joints toward the back of each segment that guide neck motion. Arthritis or bone spurs here can narrow the openings where nerves exit and cause neck and arm pain. Cervical radiculopathy.
- Spinous process
- The bony bump at the back of each vertebra, the ridge you can feel down the back of your neck. Muscles and ligaments attach here, and it is a handy landmark for orienting the scan.
What do the words on my report mean?
| Report says | In plain English |
|---|---|
| Disc bulge, protrusion | The disc has spread beyond its normal edge. A bulge is broad and even; a protrusion is a focal push in one spot, which is a little more likely to touch a nerve. |
| Disc osteophyte complex | A worn disc bulging together with a bone spur (osteophyte) at its edge, forming one ridge. The most common way a level narrows after fifty. |
| Uncovertebral hypertrophy | Bony overgrowth of the small joints at the sides of the neck vertebrae. It narrows the doorway where the nerve root exits. |
| Neural foraminal narrowing | The side doorway for one nerve root is tighter than normal. This is the finding behind most cases of a pinched nerve in the neck. |
| Central canal stenosis | The main channel for the spinal cord has narrowed. Graded mild, moderate, or severe. Mild is common and often silent. |
| Effacement of the CSF | The bright fluid around the cord has been squeezed away at that level. The first sign that the canal is getting crowded. |
| Cord flattening, cord compression | The cord itself has been pushed out of its normal round shape. Read together with the exam and with any signal change. |
| Cord signal change, myelomalacia | A bright spot inside the cord on T2 images. The cord tissue has been affected, not just the space around it. Myelomalacia is cord that has been damaged by long-standing pressure. |
| Loss of lordosis, straightening | The neck's normal forward curve is reduced. Often muscle spasm or how you were lying in the scanner; sometimes long-standing wear. |
Is it the nerve root or the spinal cord?
This distinction decides almost everything about urgency. A pinched root usually improves with time and non-surgical care, and surgery is a question of comfort and function after that care has been tried. A compressed cord does not tend to improve on its own, and the decision is about protecting function rather than treating pain. The same MRI can show both at once, and the exam settles which one is driving your symptoms.
It also decides the operation. A root is usually freed from the front through the disc space, by ACDF or cervical disc replacement. A cord compressed across several levels may need a longer decompression from the front, the back, or both. Dr. Boody will show you which structures on your scan are involved and why that leads to one plan and not another.