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LETTER TO EDITOR
Year : 2021  |  Volume : 69  |  Issue : 1  |  Page : 211

Dynamic MRI in Cervical Myelopathy: A Useful Tool?


Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India

Date of Submission24-Jan-2018
Date of Decision21-Mar-2018
Date of Acceptance12-Dec-2019
Date of Web Publication24-Feb-2021

Correspondence Address:
Kanwaljeet Garg
Department of Neurosurgery, Room No. 720, 7th Floor, CN Center, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.310103

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How to cite this article:
Singh J, Garg K, Satyarthee G D, Chandra P S, Singh M. Dynamic MRI in Cervical Myelopathy: A Useful Tool?. Neurol India 2021;69:211

How to cite this URL:
Singh J, Garg K, Satyarthee G D, Chandra P S, Singh M. Dynamic MRI in Cervical Myelopathy: A Useful Tool?. Neurol India [serial online] 2021 [cited 2021 Apr 11];69:211. Available from: https://www.neurologyindia.com/text.asp?2021/69/1/211/310103




A 22-year-old gentleman presented with the slowly progressive symptoms of progressive spastic quadriparesis over a period of 3 years along with a graduated sensory loss below the neck. There was no history of trauma and workup for motor neuron disease (clinical and EMG/NCV) was negative. The patient had the power of 3/5 to 4-/5 in his limbs and the tone was spastic (lower limbs >upper limbs). Biceps and triceps jerks were 2+ and the knee and ankle jerks were exaggerated (4+). Babinski was extensor and Hoffmann's present bilaterally. Superficial abdominal reflexes were absent. He had a 30–50% graded sensory loss below the C3 dermatome level. The trigeminal reflex was not exaggerated. Thus, a clinical diagnosis of high cervical myelopathy was made. Neutral MRI cervical spine showed a type I Chiari malformation along with myelomalacia and cervical kyphosis form C4–C6 but there was no compression of the cord on the MRI. Cerebrospinal fluid (CSF) space was clearly seen around the cervical cord from C4–C6. The patient was having signs and symptoms of high cervical compressive myelopathy but MRI showed no obvious compression, hence a decision to do dynamic flexion/extension MRI was made.[1],[2],[3],[4] The dynamic MRI showed a clear stretching of the cervical cord over the kyphotic C4–C6 segment in flexion which got relieved in neutral and extension MRI [Figure 1]. These findings changed the operative decision. Had the operative decision been made by neutral cervical MRI, then only a posterior fossa decompression for Chiari 1 malformation would have been done. The patient underwent foramen magnum decompression and C4–C6 laminectomy with lateral mass screw fixation to address his pathology.
Figure 1: T2-weighted MRI of sagittal cuts taken in flexion (a), neutral (b) and extension (c) respectively show no compression of the thinned-out cord in neutral and extension views but a bow-string effect in flexion view

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  References Top

1.
Bartlett RJ, Hill CR, Rigby AS, Chandrasekaran S, Narayanamurthy H. MRI of the cervical spine with neck extension: Is it useful? Br J Radiol 2012;85:1044-51.  Back to cited text no. 1
    
2.
Castinel BH, Adam P, Milburn PD, Castinel A, Quarrie KL, Peyrin JC, et al. Epidemiology of cervical spine abnormalities in asymptomatic adult professional rugby union players using static and dynamic MRI protocols: 2002 to 2006. Br J Sports Med 2010;44:194-9.  Back to cited text no. 2
    
3.
Muhle C, Weinert D, Falliner A, Wiskirchen J, Metzner J, Baumer M, et al. Dynamic changes of the spinal canal in patients with cervical spondylosis at flexion and extension using magnetic resonance imaging. Invest Radiol 1998;33:444-9.  Back to cited text no. 3
    
4.
Sonwalkar HA, Shah RS, Khan FK, Gupta AK, Bodhey NK, Vottath S, et al. Imaging features in Hirayama disease. Neurol India 2008;56:22.  Back to cited text no. 4
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