Dynamic Cervical Cord Compression Post-laminectomy Visualized by Flexion-extension Magnetic Resonance Imaging: Case...

Area of Science:

• Neurosurgery
• Radiology
• Spinal Imaging

Background:

• Cervical spine surgery often utilizes neutral-position MRI, but its diagnostic limitations are increasingly recognized.
• Flexion-extension MRI is not universally adopted but offers potential benefits in identifying dynamic spinal pathologies.
• Post-laminectomy complications, such as dynamic cord compression by paraspinal muscles, can lead to neurological deficits.

Observation:

• A 41-year-old male presented with neurological deficits and muscle weakness post-posterior cervical decompression.
• Initial neutral-position MRI did not reveal significant spinal stenosis requiring intervention.
• The patient's worsening tetraparesis prompted a flexion-extension MRI.

Findings:

• Flexion-extension MRI identified significant spinal stenosis in both flexion and extension positions.
• The stenosis was attributed to spondylosis and compression from posterior paraspinal muscles.
• This dynamic imaging modality effectively revealed pathology missed on static imaging.

Implications:

• Flexion-extension MRI is valuable for diagnosing cervical spine pathologies, including dynamic cord compression.
• Neutral-position MRI alone may be insufficient for comprehensive diagnosis in symptomatic patients.
• Dynamic cervical MRI should be considered when neurological symptoms are disproportionate to findings on neutral-position scans.