Kinematic MR imaging in surgical management of cervical disc disease, spondylosis and spondylotic myelopathy

Purpose. To estimate the clinical value and influence of kinematic MR imagi ng in patients with degenerative diseases of the cervical spine. Material and Methods. Eighty-one patients were examined with a 1.5 T whole body magnet using a positioning device. Cervical disc disease was classifie d according to clinical and radiographic findings into 4 stages: stage I=ce rvical disc disease (n=13); stage II=spondylosis (n=42), stage III=spondylo sis with restricted motion (n=11); and stage IV=cervical spondylotic myelop athy (n=15). Findings on kinematic MR images were compared to those on flex ion and extension radiographs, myelography, CT-myelography and static MR im aging. Furthermore, the influence of kinematic MR imaging on surgical manag ement and intra-operative patient positioning was determined. Results. Additional information obtained by kinematic MR imaging changed th e therapeutic management in 7 of 11 (64%) patients with stage III disease, and in 13 of 15 (87%) patients with stage IV disease. Instead of an anterio r approach, a posterior surgical approach was chosen in 3 of Il patients (2 7%) with stage III disease and in 6 of 15 patients (40%) with stage IV dise ase. Hyperextension of the neck was avoided intra-operatively in 4 patients (27%) with cervical spondylotic myelopathy, and in 1 patient with stage II (2%) and in patient with stage III (9%) disease. Kinematic MR imaging prov ided additional information in all patients with stages III and IV disease except in 1 patient with stage III disease, when compared to flexion and ex tension radiographs, myelography: CT-myelography and static MR examination. Conclusion. Kinematic MR imaging adds additional information when compared to conventional imaging methods in patients with advanced stages of degener ative disease of the cervical spine.