Which imaging modality is preferred to assess suspected spinal cord compression in back pain with red flags?

• A. MRI
• B. CT
• C. X-ray
• D. Ultrasound

Answer: (A)

When back pain presents with red flags suggesting possible spinal cord compression, imaging that can visualize the spinal canal and neural structures in detail is needed. MRI provides superior soft-tissue contrast, allowing clear visualization of the spinal cord, nerve roots, intervertebral discs, ligaments, and any mass effect causing compression. It can show the exact level and extent of compression and detect associated cord injury such as edema or myelopathy, as well as infections or tumors, often with contrast when needed. Because it images soft tissues well and avoids radiation, MRI is the most sensitive test for identifying compressive etiologies. CT is better for bone injuries but misses much of the soft-tissue pathology; X-ray has limited sensitivity for compression; Ultrasound isn’t effective for evaluating the spinal canal. Therefore MRI is the preferred modality.