Neurospine.
2024 Jun;21(2):443-454. 10.14245/ns.2448166.083.
Radiological and Clinical Significance of Cervical Dynamic Magnetic Resonance Imaging for Cervical Spondylotic Myelopathy
- Affiliations
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- 1Department of Neurosurgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
- 2Department of Neurosurgery, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
- 3Department of Neurosurgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
- 4Department of Hospital Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
- 5Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University School of Medicine, Seoul, Korea
- 6Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
- 7Arthur A. Dugoni School of Dentistry, University of Pacific, Stockton, CA, USA
- 8POSTECH Biotech Center, Pohang University of Science and Technology, Pohang, Korea
- KMID: 2557019
- DOI: http://doi.org/10.14245/ns.2448166.083
Abstract
Objective
The study compared the morphometric changes of the cervical spinal cord using dynamic magnetic resonance imaging (MRI) in patients with cervical spondylotic myelopathy (CSM) and assessed the correlation with kinematic changes, cord cross-sectional area (CSA), and high signal intensity (SI) on T2-weighted imaging (T2WI).
Methods
Patients with CSM were evaluated through dynamic MRI for sagittal and axial CSA changes of the cervical cord, cerebrospinal fluid (CSF) reserve ratio, degree of cord impingement, cord compression rate, range of motion (ROM), and severity of SI on T2WI. The degree of cord impingement was evaluated using the Muhle grading system. Clinical outcomes were assessed using Japanese Orthopaedic Association scoring and Nurick grade.
Results
The study included 191 patients (113 males) with a mean age of 55.34 ± 12.09 years. The lowest sagittal CSF reserve ratio and cord occupation rate were observed during extension. Cord impingement and SI change were more prevalent in extension-positioned MRI. There was no difference between ROM on dynamic radiographs and dynamic MRI. Preoperative cervical ROM was greater in patients with intensely high SI change.
Conclusion
Dynamic MRI is useful for evaluating neck movement. Patients with high SI had greater ROM before surgery but worse outcomes after. Neck extension exacerbated cervical stenosis and cord compression compared to flexion, and cervical spinal motion contributed to the severity of CSM. Cervical spinal motion should be carefully evaluated, particularly in hyperextension, to prevent worsening of CSM.
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