Upright weight-bearing cervical flexion/extension dynamic magnetic resonance imaging: Case report and review of the literature

Conventional recumbent magnetic resonance imaging (MRI) of the cervical spine may underestimate disease because the imaging is performed in a non-dynamic, non-weight bearing position. The cervical myelogram may provide additional information but requires an invasive procedure and a post-myelogram computed tomography (CT) scan. We present a patient with cervical symptomatology imaged in an upright weight-bearing sitting position in the flexion, neutral, and extension positions. Measurements of the anterior to posterior midsagittal plane were obtained at several disc space levels. The T₂ sagittal images are presented and compared. This case clearly shows a reduction in the anterior-posterior distance in the midsagittal plane progressively from flexion to neutral to extension with the extension position showing the greatest reduction in cervical central canal diameter. Images show a decrease in anterior and posterior subarachnoid space in the extension position. Upright weight bearing cervical flexion/extension dynamic magnetic resonance imaging provides an innovative noninvasive technique to see changes in midsagittal cervical spinal canal diameter and may provide for imaging of the dynamic nature of spinal cord compression.