The Role of Dynamic Cervical Magnetic Resonance Imaging in Determining the Level of Posterior Decompression in Cervical Spondylotic Myelopathy

Abstract

BACKGROUND: Cervical spondylotic myelopathy (CSM) is a leading cause of spinal cord dysfunction in adults, often progressing silently. Static magnetic resonance imaging (MRI) is the standard imaging tool but may miss compression caused by neck movement. Dynamic MRI, by capturing flexion and extension views, provides a clearer picture of spinal cord compression, aiding surgical planning and improving outcomes. However, its use is limited due to higher costs and specialized requirements, making its clinical value essential to assess. METHODS: Eighty-two CSM patients undergoing posterior decompression surgery were divided into 2 groups: static MRI-based planning (n = 43) and combined static and dynamic MRI-based planning (n = 39). Neurological outcomes were evaluated using modified Japanese Orthopaedic Association and visual analog scale scores preoperatively and postoperatively. Compression levels identified on static and dynamic MRI were compared. RESULTS: Demographic characteristics were similar between groups. Dynamic MRI identified additional compression levels, mainly at C5-C6 and C6-C7, in 18 patients. Patients in the dynamic MRI group showed significantly greater improvements in modified Japanese Orthopaedic Association scores (mean: 15.8 +/- 1.6 vs. 14.5 +/- 1.8, P = 0.01) and visual analog scale scores (mean: 3.2 +/- 1.4 vs. 4.5 +/- 1.8, P = 0.01) compared to the static MRI group. CONCLUSIONS: Dynamic cervical MRI enhances the identification of compression levels overlooked by static MRI, improving surgical precision and postoperative outcomes in CSM patients. Incorporating dynamic MRI into routine preoperative evaluations may be particularly beneficial for complex, multilevel cases.