EXACERBATED PAIN IN CERVICAL RADICULOPATHY AT AXIAL ROTATION, FLEXION, EXTENSION, AND COUPLED MOTIONS OF THE CERVICAL-SPINE - EVALUATION BYKINEMATIC MAGNETIC-RESONANCE-IMAGING

RATIONALE AND OBJECTIVES. The authors evaluate the functional changes in patients with cervical radiculopathy and increasing symptoms after provocative maneuvers at flexion, extension, axial rotation, and coupl ed motions of the cervical spine. METHODS. Twenty-one patients with ce rvical disc herniation (n = 17) Or cervial spondylosis (n = 4) in whom symptoms were elicited at flexion, extension, axial rotation, and cou pled motions of the cervical spine were studied. The patients were exa mined inside a positioning device by using a circular surface coil for signal reception, At neutral position (0 degrees) and at provocative positions sagittal T2-weighted turbo spin-echo, axial T2-weighted two- dimensional flash sequence, sagittal three-dimensional (3D) fast imagi ng with steady state precision sequence and coronal 3D double-echo-in- the-steady-state sequences were obtained. The 3D sequences were reform atted in the axial and oblique coronal planes perpendicular to the exi ting nerve roots. The images were evaluated for the size of disc herni ations, the foraminal size and cervical cord rotation or displacement at provocative position compared with neutral position (0 degrees). RE SULTS. Compared with neutral position (0 degrees), change in size of d isc herniation was not found in any (0 %) of the provocative positions . In five (24%) patients cervical cord rotation or displacement was no ted at axial rotation. The foraminal size increased at flexion, axial rotation to the opposite side of pain and flexion combined with axial rotation to the opposite side of the pain. The foraminal size decrease d at extension combined with axial rotation to the side of the pain. A decrease or no change in foraminal size was observed at either extens ion or axial rotation to the side of the pain. CONCLUSIONS. In patient s with cervical disc herniation or cervical spondylosis, exacerbated p ain at defined provocative maneuvers is related more to changes in the foraminal size and to nerve root motion with, in some cases, cervical cord rotation or displacement than to changes in the size of herniate d discs.