title: Does Dynamic Supine Magnetic Resonance Imaging Improve the Diagnostic Accuracy of Cervical Spondylotic Myelopathy? A Review of the Current Evidence.
abstract: OBJECTIVE
  We aimed to critically analyze the current evidence regarding the role of dynamic supine magnetic resonance imaging (dsMRI) in the evaluation of cervical spondylotic myelopathy.
  
  
  METHODS
  Thirteen studies were identified through a comprehensive literature search performed in the PubMed, EMBASE, and ISI databases as fulfilling the inclusion criteria and were reviewed for subject characteristics, radiographic parameters, and salient findings.
  
  
  RESULTS
  Studies herein reviewed suggested that dsMRI was able to detect new appearance or increased grade of medullary compression in ≥20% of patients and to demonstrate an average narrowing of the cervical canal by 20% (in comparison with the neutral position). Several additional parameters were investigated, but their clinical significance remained unconfirmed. Two studies examined how surgical decision-making could be affected by the additional findings of dsMRI.
  
  
  CONCLUSIONS
  dsMRI represents an available modification of conventional static magnetic resonance imaging and is potentially able to demonstrate pathologies that might be previously missed. Evidence suggests that dsMRI can elucidate spinal cord compression with higher sensitivity, resulting in improved diagnostic accuracy of cervical spondylotic myelopathy, which may impact surgical planning for these patients. However, more high-quality studies are required to further establish its indications to avoid overdiagnosis with this powerful imaging technique and to justify its cost-effectiveness.
authors.affiliation: Department of Orthopaedics, Peking University Third Hospital, Beijing, People's Republic of China.
authors.forename: Nanfang
authors.initials: N
authors.lastname: Xu
authors.affiliation: Department of Orthopaedics, Peking University Third Hospital, Beijing, People's Republic of China. Electronic address: puthwangshaobo@163.com.
authors.forename: Shaobo
authors.initials: S
authors.lastname: Wang
authors.affiliation: Department of Radiology, Peking University Third Hospital, Beijing, People's Republic of China.
authors.forename: Huishu
authors.initials: H
authors.lastname: Yuan
authors.affiliation: Department of Orthopaedics, Peking University Third Hospital, Beijing, People's Republic of China.
authors.forename: Xiaoguang
authors.initials: X
authors.lastname: Liu
authors.affiliation: Department of Orthopaedics, Peking University Third Hospital, Beijing, People's Republic of China. Electronic address: puthliuzhongjun@163.com.
authors.forename: Zhongjun
authors.initials: Z
authors.lastname: Liu
mesh_terms: D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging* / Q000473:pathology; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007089:Image Enhancement; D008279:Magnetic Resonance Imaging / Q000592:standards*; D008297:Male; D008875:Middle Aged; D056888:Patient Positioning / Q000706:statistics & numerical data; D015995:Prevalence; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013117:Spinal Cord Compression / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000473:pathology; D055009:Spondylosis / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000473:pathology; D016683:Supine Position
keywords: Cervical canal stenosis; Cervical spondylotic myelopathy; Dynamic magnetic resonance imaging; Extension magnetic resonance imaging; Flexion magnetic resonance imaging; Medullary compression