Degenerative cervical myelopathy (DCM) is a common cause of disability, but mild patients are often managed non-operatively and monitored for deterioration. Popular clinical assessment tools are insensitive to detect subtle disease progression. In this study, we employ multi-parametric spinal cord MRI to monitor 15 DCM patients for progression over a 1-year period, in addition to a comprehensive battery of clinical assessments. The MRI results detected progressive tissue injury in 6/7 patients with definite clinical progression and 5 additional patients (4 of which had borderline clinical progression). These MRI assessments are now being incorporated into clinical practice to inform surgical decision-making.