When it comes to the cervical spine, cord integrity matters most. Even mild changes can spell trouble if the cord is compromised.
The Big Picture
Cervical canal stenosis isn’t just about the degree of narrowing; it’s about whether the spinal cord, itself, is at risk, too. Even without measurable stenosis, cord flattening can cause myelopathy. Understanding Dr. Lea Alhilali’s fishbowl analogy helps clarify how to distinguish mild, moderate, and severe cases.
Key Takeaways
- Cord first: Regardless of canal narrowing, deformity or signal changes in the cord point to a higher risk of myelopathy.
- Not just static: Static imaging may underestimate the impact; dynamic forces, repetitive microtrauma, or microischemia may drive symptoms.
- Dr. Alhilali’s fishbowl analogy . . .
- Mild stenosis:
- Either ventral or dorsal CSF is effaced, but the cord still has room to “swim.”
- Moderate stenosis:
- Both ventral and dorsal CSF are lost, restricting cord movement.
- Severe stenosis:
- No CSF remains—cord is compressed, “fish” crushed.
- Mild stenosis:
Challenges Ahead
- Why cord flattening causes myelopathy without stenosis remains unclear, and mechanisms are still debated.
- Dynamic assessment may offer better insight than static MRI but isn’t standardized.
- Management depends on correlating imaging with clinical findings, which are often nuanced.
Bottom Line
Think of the cervical cord like a fish in a bowl: it needs space to move. Once the CSF “water” is gone, the cord, as well as the patient, suffers. Classifying stenosis by available space—not merely narrowing—sharpens diagnostic accuracy and clinical relevance.
This lecture comes from “The ABC’s of Degenerative Spine Imaging” by Lea Alhilali, MD, part of ARRS’ Neuroradiology Longitudinal Course: Essential Topics and Cases for Everyday Practice.
Next in the series: THURSDAY, OCTOBER 30
Seizure, dementia, and metabolic disorders—an intersection of neurology, psychiatry, and radiology.
| Lecture Title | Speaker Name | Lecture Start Time |
| Welcome | Charlotte Taylor | 12:00 PM |
| Altered Mental Status, Seizure and Beyond | Abdel Mahammedi | 12:05 PM |
| Epilepsy Detection | Erik H. Middlebrooks | 12:30 PM |
| Non-AD Dementia Disorders | Petrice Cogswell | 12:55 PM |
| Alzheimer’s Disease and New Therapeutics | Suzie Bash | 1:20 PM |
| Q and A | 1:45 PM |