January/February - West Virginia State Medical Association

Scientific Article |
Figure 1d
T2 extension MRI axial cut through the
level of C4-5 depicting moderate to severe
canal compromise.
thecal sacs at the C6-C7 level, causing
moderate central canal stenosis.
Figure 1d shows an axial view
through the level of C4-5 in extension
and demonstrates moderate to
severe canal compromise.
Figures 3a-d are examples of noninvasive
MR-myelography combining
flexion and extension views. Flexion
films, seen in lateral (Figure 3a) and
antero-posterior views (Figure 3b),
show minimal amounts of spinal
cord effacement. The extension
films, also seen in lateral (Figure 3c)
and antero-posterior (Figure 3d)
views, more dramatically show the
effacement (areas of hypointensity)
of the spinal cord at the levels
of C4-C5 (severe stenosis) and
C6-C7 (moderate stenosis).
Treatment:
We discussed with the patient
his pathology and surgical
options. The issues of posterior
decompression with laminectomy
versus multi-level discectomy and
fusion are beyond the scope of this
discussion. The patient elected for
posterior cervical decompression.
A laminectomy from C3 to C6 was
performed. No instrumentation or
fusion technique was utilized. At last
follow-up, the vast majority of his
symptoms had abated, and he was
back to normal levels of activity.
Discussion
Posterior compression of
the cervical spinal cord by the
ligamentum flavum along with
multiple level disc herniations, in
association with a narrow cervical
canal, was the cause of progressive
myelopathy in this patient.
A recent study by Chen et al
was conducted to determine if
there were any neutral-position
imaging criteria that would predict
functional cord impingement at
flexion-extension cervical magnetic
resonance (MR) imaging. They
used five criteria of neutral position
MRI to predict functional cord
impingement including: cervical
curvature, spinal canal space, cervical
degeneration, resting instability,
and intramedullary high intensity
signal on T2 MRI 1. They found that
none of their criteria had the ability
to predict impingement by flexion
MRI; however there was a probable
increase of cord impingement to 79%
with extension MRI if spinal canal
diameter and cervical degenerative
Figure 3a, 3b
Lateral and anterior-posterior views of MR-Myelogram in flexion.
12 West Virginia Medical Journal