The Importance Of Dynamic Cervical MRI In The Diagnosis And Treatment Of Cervical Spondilotic Myeloradiculopathy

Research Article

Abstract

Introducttion and Objective: Cervical spondylotic myelopathy and cervical spondylotic radiculopathy are the most common degenerative spine pathologies in middle-aged individuals. The cervical vertebra is the most mobile part of the spine. Although radiological examinations give information about the structure of the spine, they do not provide any functional data. This study aimed to investigate whether dynamic magnetic resonance imaging helps make the surgical decision of cervical spondylotic myelopathy.

Method: In this study, the clinical features, radiological findings and surgical results of 258 SSM and/or CSR patients, 123 women and 135 men, who underwent surgical treatment were examined. Canal diameters on lateral radiographs and anterior-posterior diameters on axial CT sections were measured for all levels. The diameters of the canal were measured for all levels in the flexion, extension, and neutral anteroposterior axial MRI section. The clinical status of the patients was evaluated according to the four common classifications used for SSM (JOA, Nurick, Mann and Symon, and Launder).

Results: According to the mean AP diameter values in dynamic MRI examinations, it was observed that the canal expanded by an average of 1.05 mm (14.9%) in flexion (8.09 mm) and narrowed by 0.94 mm (13.4%) in extension (6.10 mm). The difference between mean flexion and extension MRI results was 1.99 mm. The difference between MRI and CT measurements was statistically significant (Student t-test, p<0.001, Wilcoxon signed-rank test, p<0.05). Dynamic MRI has been found to be particularly helpful in visualizing the dynamic causes of SSM etiology. While instability was suspected in 25.6% of the cases in routine X-rays, instability was found in 54.3% after dynamic MRI examinations. It is observed that retrolisthesis especially in hyperextension and segmental excessive movement in hyperflexion.

Conclusion: Correlation between transverse area measurements as well as sagittal and axial dynamic MR images taken during flexion and extension should be established, and surgical planning should be done accordingly. Cord compression and transverse area of the cord, changes in the spinal cord area, and subarachnoid space, the most important prognostic indicators in spinal cord diseases, can be detected by dynamic axial sections of MR images. Dynamic MR images can assist in decision-making regarding the surgical management of cervical spondylotic myelopathy.