MRI of the cervical spine with neck extension: is it useful?
OBJECTIVE
Standard MRI of the cervical spine is performed in a different anatomical position to that utilised for traditional contrast myelography. Those well practised in myelography are familiar with the considerable changes in configuration of the bony and soft tissues of the cervical spine that may occur with changes in the degree of neck flexion and extension. We set out to compare the findings in a select group of patients with myeloradiculopathy who had undergone myelography and MRI in both standard and neck-extended positions. These findings were correlated with the clinical status.


METHODS
29 patients underwent myelography with CT (CTM) and MRI in neutral and neck-extended positions. The imaging was assessed for the degree of cord compression and neural foraminal narrowing, quantified using a simple grading scheme suitable for routine clinical practice. The degree of neck extension was assessed using an angular measurement.


RESULTS
For both CTM and MRI, scanning with the neck extended significantly increases the severity of cord compression compared with the standard supine position, to a degree similar to that shown during conventional prone myelography. The degree of perceived cord compression is related to the degree of neck extension achieved. Correlation of standard MRI findings and the clinical level of radiculopathy is poor. This correlation improves when the neck is extended.


CONCLUSIONS
The most appropriate position for routine MRI of the cervical spine in degenerative disease remains unknown, but in selected patients imaging with the neck extended may provide important additional information.
Royal Hull Hospitals, Hull, UK. richard.bartlett@hey.nhs.uk
R J V
RJ
Bartlett
C A Rowland
CA
Hill
A S
AS
Rigby
S
S
Chandrasekaran
H
H
Narayanamurthy
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009192:Myelography / Q000379:methods; D015588:Observer Variation; D016684:Prone Position; D011843:Radiculopathy / Q000175:diagnosis*; D012189:Retrospective Studies; D013117:Spinal Cord Compression / Q000175:diagnosis*; D016683:Supine Position; D014057:Tomography, X-Ray Computed