Utility of cervical dynamic magnetic resonance imaging for evaluating patients with cervical myelopathy: a retrospective study

Abstract

Study Design Retrospective observational study. Purpose This study aimed to evaluate the utility of cervical dynamic magnetic resonance imaging (dMRI) in the assessment of cervical canal stenosis. Overview of Literature Cervical spondylotic myelopathy has been intricately linked to both static and dynamic narrowing of the cervical spinal canal. Traditional MRI with the neck in a neutral position fails to identify the dynamic changes and may lead to misdiagnosis. Cervical dMRI is a promising tool for evaluating cervical myelopathy, enabling clinicians to assess spinal cord compression, segmental instability, and alterations in range of motion, often missed on conventional imaging. Methods A retrospective analysis was conducted on 369 patients with symptoms of cervical myelopathy assessed using cervical dMRI. After assessing the subaxial cervical spine at each disc level (C3–T1), significant changes in the degree of central canal stenosis were determined. The appearance and extent of hyperintense lesions on T2-weighted sequences were also noted. Results Overall, 653/1,845 (35.39%) disc levels showed an increase in stenosis grade on extension MRI, with 168/653 (25.72%) and 180/653 (27.56%) disc levels changing from grades 0/1 to grades 2 and 3, respectively. Moreover, 120/369 (32.52%) patients showed a mean increase of 1.55±0.75 levels of compression on extension MRI when compared to neutral MRI. A fresh-appearing hyperintense lesion was observed in 79 (4.28%) disc levels on flexion MRI, which was not visualized on neutral MRI. Conclusions Cervical dMRI may help surgeons plan for surgery, discuss the prognosis with the patient, and safeguard themselves from medico-legal issues arising from improper or missed diagnosis and treatment.

Keywords

• cervical vertebrae
• dynamic magnetic resonance imaging
• dynamic stenosis