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|LETTER TO EDITOR
|Year : 2021 | Volume
| Issue : 1 | Page : 211
Dynamic MRI in Cervical Myelopathy: A Useful Tool?
Jaskaran Singh, Kanwaljeet Garg, GD Satyarthee, PS Chandra, Manmohan Singh
Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
|Date of Submission||24-Jan-2018|
|Date of Decision||21-Mar-2018|
|Date of Acceptance||12-Dec-2019|
|Date of Web Publication||24-Feb-2021|
Department of Neurosurgery, Room No. 720, 7th Floor, CN Center, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110 029
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Singh J, Garg K, Satyarthee G D, Chandra P S, Singh M. Dynamic MRI in Cervical Myelopathy: A Useful Tool?. Neurol India 2021;69:211
A 22-year-old gentleman presented with the slowly progressive symptoms of progressive spastic quadriparesis over a period of 3 years along with a graduated sensory loss below the neck. There was no history of trauma and workup for motor neuron disease (clinical and EMG/NCV) was negative. The patient had the power of 3/5 to 4-/5 in his limbs and the tone was spastic (lower limbs >upper limbs). Biceps and triceps jerks were 2+ and the knee and ankle jerks were exaggerated (4+). Babinski was extensor and Hoffmann's present bilaterally. Superficial abdominal reflexes were absent. He had a 30–50% graded sensory loss below the C3 dermatome level. The trigeminal reflex was not exaggerated. Thus, a clinical diagnosis of high cervical myelopathy was made. Neutral MRI cervical spine showed a type I Chiari malformation along with myelomalacia and cervical kyphosis form C4–C6 but there was no compression of the cord on the MRI. Cerebrospinal fluid (CSF) space was clearly seen around the cervical cord from C4–C6. The patient was having signs and symptoms of high cervical compressive myelopathy but MRI showed no obvious compression, hence a decision to do dynamic flexion/extension MRI was made.,,, The dynamic MRI showed a clear stretching of the cervical cord over the kyphotic C4–C6 segment in flexion which got relieved in neutral and extension MRI [Figure 1]. These findings changed the operative decision. Had the operative decision been made by neutral cervical MRI, then only a posterior fossa decompression for Chiari 1 malformation would have been done. The patient underwent foramen magnum decompression and C4–C6 laminectomy with lateral mass screw fixation to address his pathology.
|Figure 1: T2-weighted MRI of sagittal cuts taken in flexion (a), neutral (b) and extension (c) respectively show no compression of the thinned-out cord in neutral and extension views but a bow-string effect in flexion view|
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