Leukodystrophies, deficiency-related metabolic diseases, genetic and acquired toxic/metabolic causes, and mitochondrial diseases were identified as the genetic and metabolic disorders of adulthood producing spinal cord signal changes. A number of adult metabolic and genetic illnesses that cause spinal cord atrophy without signal changes have also been discovered. The classification based on spinal MRI results is also offered, along with suggestions for the diagnostic process and alternative diagnoses.