Degenerative cervical myelopathy [DCM] is a progressive, spinal cord injury, estimated to affect 1 in 50 adults. Spinal cord compression from degenerative changes of the cervical spine, such as intervertebral disc prolapse, osteophyte formation or ligament thickening have been considered the disease hallmark. Assessment of spinal cord compression using Magnetic Resonance [MRI] has therefore become a gold standard assessment for diagnosis and popular outcome assessment. This approach has limitations, which are poorly recognised in clinical care and research, representing a knowledge translation gap. Improving MRI assessment of DCM is therefore a recognised research priority. A range of different approaches are at various stages of development and may offer improved assessments of DCM. Multi-parametric quantitative MRI, including diffusion-based imaging, is one prominent example. Structural MRI, the sequences routinely used in clinical care today, too may offer additional and/or more readily accessible information. For example, the nature and interaction of degenerative pathology, or in combination with finite element analysis. This thesis tests the hypothesis, “the application and/or interpretation of MRI can be optimised to improve the diagnosis, monitoring and/or surgical decision making of Degenerative Cervical Myelopathy” using a variety of research methodologies.

Initially using systematic review and consensus, tools are developed to support knowledge translation around structural MRI today. Then the practicalities, validity, and value of implementing multi-parametric quantitative MRI are considered using a cohort of patients undergoing surgery and a targeted protocol. Then it explores the clinical significance of the presence or absence of degenerative pathology to the diagnosis of DCM. Finally, it explores a role for finite-element analysis to extend MRI, through a systematic review and development of a computational model.

This research therefore creates recommendations for current practice, whilst exploring new imaging solutions for DCM. Overall, its findings support the shifting focus of DCM as a disease of spinal cord compression to instead a disease defined by mechanical stress, vulnerability, and time with injury.