The “pancake-like” enhancement in cervical spondylotic myelopathy

Cervical spondylotic myelopathy, characterized by chronic spinal cord compression resulting from degenerative spine changes, manifests with a spectrum of neurological and pain symptoms. Despite the complexity of intramedullary spinal cord abnormalities, employing a systematic approach to differential diagnosis, considering factors such as lesion location, cord length, segment involvement, and enhancement pattern, can significantly aid in narrowing down the potential diagnoses, potentially avoiding invasive diagnostic procedures and guiding treatment decisions. This article presents two cases of cervical spondylotic myelopathy characterized by progressive weakness and paraesthesia, exhibiting progressive bilateral upper extremity numbness, tingling, and impaired gait, with cervical myelopathy evident on MRI displaying transverse pancake-like gadolinium enhancement.