Project Summary Cervical spondylotic myelopathy (CSM) is a common degenerative condition of the cervical spine that leads to pain and progressive spinal injury. Primary drivers of clinical injury in CSM include forward head posture (a biomechanical process) and spinal compression (a neuromechanical process). The current proposal seeks to define clinically-relevant radiographic biomarkers, using standard X-ray and Magnetization Transfer-MRI images, to investigate the role of head posture and spinal compression in CSM patients and age-matched controls. These biomarkers will then be directly correlated to anatomically-specific tests of clinical function, including pain, disability, strength, and coordination. The long-term goal is to develop standardized radiographic values and thresholds that can be used to identify appropriate surgical candidates and predict prognosis.