Spinal non-traumatic extradural emergencies: what the radiologist needs to know

Abstract Spinal non-traumatic extradural emergencies (SNTEE) represent critical emergencies that demand prompt recognition and intervention to prevent irreversible neurologic deficits. Radiography offers rapid initial evaluation of alignment and gross osseous changes in resource-limited settings, while CT provides superior characterization of bone architecture, subtle fractures, endplate erosion in spondylodiscitis and is essential for surgical planning. Magnetic resonance imaging (MRI) is currently considered the reference standard for evaluation of spinal non-traumatic extradural emergencies, lesion characterization and differential diagnosis, thanks to its superior soft tissue contrast and ability to distinguish extradural, intradural, and intramedullary pathologies. This review emphasizes the importance of a standardized MRI to differentiate infectious, neoplastic, traumatic and degenerative causes of acute compressive myelopathy. Furthermore, we highlight characteristic imaging features of key pathologies -such as spinal infections, neoplastic lesions, osteoporotic fractures, degenerative conditions and spontaneous epidural hematomas- providing practical tips for accurate identification.