Role of Kinematic Magnetic Resonance Imaging for Evaluation of Cervical Spondylotic Myeloradiculopathy: Diagnostic Accuracy and Surgical Planning

ABSTRACT

Objective

The dynamic part of cervical spondylotic myeloradiculopathy (CSM) is conventionally being evaluated using static magnetic resonance imaging (MRI), which does not address dynamic changes in flexion and extension of the cervical vertebral column. The objective of the study is to evaluate the utility of kinematic MRI imaging in diagnostic accuracy and surgical planning of evaluation of CSM.

Materials and methods

In a prospective study, 30 patients with CSM were evaluated with conventional standard MR cervical spine and kinematic MRI cervical spine with flexion and extension. Morphometric measurements were compared between neutral, flexion, and extension images.

Results

The cervical cord length and cervical canal length were significantly longer in flexion and significantly shorter in extension in all cervical cord sagittal lines. Flexion was associated with decrease in spinal cord compression in 40% of patients, whereas extension caused increase in compression (increase in the size of T2 hyperintensivity) in 75% of patients. Extension identified new subtle T2 hyperintensities. Interpretation of standard MRI findings and the clinical level of radiculopathy is poor, which improves when the neck is extended.

Conclusion

Our results suggest that integration of kinematic MRI with standard static MRI provides additional information in diagnostic accuracy and surgical planning.